Even though neonatal cooling therapy is a widely proven and generally accepted treatment for newborns experiencing HIE, it's important for medical providers to carefully follow strict procedures and steps to ensure the effectiveness of the therapy and avoid potential negative impacts. Failure to follow these procedures can negate the treatment and cause further injury. Here are some common examples of how therapeutic hypothermia in babies can go wrong: A baby is given hypothermic therapy too late (after 6-12 hours of birth) Failure to transfer the infant to an appropriate facility with active hypothermia capabilities A baby's core body temperature is rewarmed too quickly, resulting in a reperfusion injury A newborn who doesn't meet the eligibility criteria (i.e. is pre-term, has an APGAR score above 5, etc.) is given cooling therapy Cooling measures are not reduced or stopped when the baby's rectal temperature falls below 95 degrees Fahrenheit The rectal thermometer isn't properly inserted, thus resulting in incorrect readings of the baby's temperature Failure to manage acidosis (acid in blood) A baby exhibiting signs of stress is not given sedation, since stress has been shown to negate the effects of hypothermia therapy Sodium and chloride levels are not monitored and fall below normal levels The medical team fails to maintain normal glucose and electrolyte levels Oxygen saturation levels aren't properly monitored, as cooled infants are at risk of persistent pulmonary hypertension Doctor fails to provide respiratory and cardiovascular support as needed Insufficient testing for and treating of infections