Overcoming Barriers to Holding Babies with Hypoxic-Ischemic Encephalopathy During Therapeutic Cooling

Key Takeaways

• Only 38% of NICUs currently allow holding during cooling
• Recent studies show holding does not cause temperature instability
• The HIE hold‑a‑thon launches in 40+ NICUs worldwide
• Polar‑bear care framework integrates trauma‑informed principles for parents
• Coordinated implementation can close evidence‑practice gaps in neonatal care

Pulse Analysis

Hypoxic‑ischemic encephalopathy (HIE) affects roughly 1–3 per 1,000 live births, causing brain injury from oxygen deprivation. The standard of care, therapeutic hypothermia, cools infants for 72 hours to limit neuronal death. While the treatment improves survival and neurodevelopmental outcomes, it also isolates newborns from parents, preventing skin‑to‑skin contact that is known to reduce stress and support bonding. Historically, NICUs have prohibited holding because of concerns about wires, temperature regulation, and seizure risk, despite limited data on actual harm.

Emerging research, though based on modest sample sizes, demonstrates that parental holding during cooling does not produce clinically significant temperature swings or vital‑sign instability. An international NICU survey revealed that only 38 percent of units currently permit holding, underscoring a gap between evidence and practice. The barriers are largely structural—staffing logistics, protocol inertia, and cultural risk aversion—rather than safety concerns. Implementation science suggests that targeted education, standardized protocols, and real‑time monitoring can overcome these obstacles, allowing families to engage in nurturing contact without compromising treatment efficacy.

The inaugural HIE hold‑a‑thon, organized by the Newborn Brain Society and Hope for HIE, will roll out customized holding protocols in more than 40 NICUs across several countries beginning April 1. By embedding the “polar‑bear care” framework—six trauma‑informed principles—into daily practice, the initiative aims to normalize parent‑infant contact during therapeutic hypothermia. Coordinated, multi‑site implementation creates momentum, shares best‑practice lessons, and reduces the isolation clinicians feel when changing entrenched routines. If successful, the hold‑a‑thon could serve as a blueprint for closing evidence‑practice gaps in other specialties, accelerating patient‑centered care.