Therapeutic Hypothermia Eligibility Tool

Q: Who is eligible for cooling?

Infants 36 weeks or more, within 6 hours of birth, meeting biochemical or clinical criteria (e.g., cord/early pH ≤7.0 or base deficit ≥16; or pH 7.01–7.15 with a perinatal event plus a 10-minute Apgar ≤5 or ongoing resuscitation) and showing moderate-to-severe encephalopathy.

Q: When must cooling start and for how long?

Within 6 hours of birth, maintained at a target of 33.5 °C for 72 hours, followed by gradual rewarming.

Decision-support tool based on the KP Riverside NICU Manual therapeutic hypothermia guideline. The neonatologist makes the final determination; cooling may be offered outside these criteria at clinician discretion after discussing risks and benefits with the family.

Inclusion gates

Gestational age (wk)

Birth weight (g)

Age at evaluation (h)

Criteria A — clinical & biochemical (need A1 or A2)

Cord / first gas pH (<1 h)

Base deficit (mEq/L)

Enter the magnitude (e.g. 16 for −16)

A2 pathway (used when gas unavailable, pH 7.01–7.15, or base deficit 10–15.9):

Acute perinatal eventAbruption, cord prolapse, or severe FHR abnormality (late/variable decels)Apgar ≤ 5 at 10 minutesContinued ventilation from birth for ≥ 10 minutes

A1 — · A2 —

Criteria B — neurologic (seizures, or ≥3 of 6 categories)

Clinical or electrographic (EEG) seizures

Moderate-to-severe encephalopathy — check each category with ≥1 sign:

Level of consciousnessLethargic (moderate) → stupor/coma (severe)Spontaneous activityDecreased (moderate) → no activity (severe)PostureDistal flexion / full extension (moderate) → decerebrate (severe)ToneHypotonia (moderate) → flaccid (severe)Primitive reflexesWeak suck / incomplete Moro (moderate) → absent (severe)Autonomic systemConstricted pupils, bradycardia, periodic breathing (moderate) → dilated non-reactive pupils, variable HR, apnea (severe)

Categories with a sign: 0 / 6

Exclusion criteria

Known chromosomal / severe congenital anomaly / metabolic disorderHead trauma or skull fracture causing major intracranial hemorrhageIntractable coagulopathy with active bleedingParent refusal

KP Riverside Neonatal ICU Manual — Practice Guideline: Therapeutic Hypothermia (§17.4).

California Perinatal Quality Care Collaborative. Early Screening and Identification of Candidates for Neonatal Therapeutic Hypothermia Toolkit. 2015.

Frequently asked questions

Who is eligible for cooling?

Infants 36 weeks or more, within 6 hours of birth, meeting biochemical or clinical criteria (e.g., cord/early pH ≤7.0 or base deficit ≥16; or pH 7.01–7.15 with a perinatal event plus a 10-minute Apgar ≤5 or ongoing resuscitation) and showing moderate-to-severe encephalopathy.

When must cooling start and for how long?

Within 6 hours of birth, maintained at a target of 33.5 °C for 72 hours, followed by gradual rewarming.

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