Brain Cooling Hypothermic Therapy
When a newborn baby is deprived of full levels of oxygen for even a few minutes, the consequences can be severe. Treatment options for infants with a shortage of oxygen during the birthing process have often been limited or nonexistent.
However, a relatively new treatment option known as brain cooling or neonatal therapeutic hypothermia shows promising signs that it could prevent countless future children from dying or developing brain damage.
Learn more about the revolutionary treatment option and how it works.
What is Hypoxic-Ischemic Encephalopathy?
Before getting into the details of brain cooling, it’s important to understand the condition the treatment is trying to prevent.
When the brain receives inadequate levels of oxygen, the brain is incapable of functioning properly and brain cells begin to die. When this happens during birth, it is known as hypoxic-ischemic encephalopathy (HIE).
Not only can a reduction in oxygen to the infant cause brain damage but it can also result in death. In fact, up to 20 percent of infants who suffer brain injury from a shortage of oxygen die within the first month of their life1. Another 30 percent of those who survive will suffer a severe neurodevelopmental disorder.
Most estimates put the incidence rate somewhere between 2 to 9 per 1000 births.
Some of the most common signs of HIE are reduced consciousness, seizures, difficulty breathing, low Apgar scores, abnormal heart rate, and depression of reflexes.
Causes of Hypoxic-Ischemic Encephalopathy
The underlying condition that causes HIE is something called perinatal asphyxia or birth asphyxia. This is a medical condition in which a newborn is deprived of oxygen. Physical harm can be caused to other parts of the body like the heart and lungs. However, it is more common and notable for the brain to suffer damage, which is HIE.
Asphyxiation can occur before, during, and after birth. As a result of the fairly wide timespan in which damage to the brain can take place, the causes are varied.
The most common causes of HIE include:
- Uterine rupture
- Umbilical cord prolapse
- Placental separation
- Very low maternal blood pressure
- Placenta covering the cervix
- Should dystocia
Effects of Hypoxic-Ischemic Encephalopathy
The consequences of HIE depend on the severity of damage done to the brain.
Roughly half of the babies suffering from HIE at the time of birth will only experience minor symptoms and will usually grow up without complications. The other half of infants with HIE will die by 2 years of age or have severe disabilities2. The milder consequences of HIE in the children who show normal development have yet to be fully explored.
Children with severe HIE who do not die at an early age will often develop severe impairments. These include:
- Cerebral palsy
- Mental retardation
- Visual Impairment
- Developmental delays
In cases of cerebral palsy, signs and symptoms sometimes don’t manifest themselves until children get older.
Because cerebral palsy is a name for a group of disorders, the symptoms and severity vary from person to person, according to the Centers for Disease Control and Prevention3. However, cerebral palsy often becomes evident as children fail to reach motor or movement milestones — like sitting, rolling over, standing, and crawling — at the typical ages.
The Concept of Brain Cooling
For the longest time, there have been few ways to prevent HIE from doing damage and taking lives. Doctors often had to resort to treating the effects of HIE after the damage had been done. More recently, a treatment option called brain cooling has proven itself effective.
Brain cooling goes by several names: hypothermia therapy, therapeutic hypothermia, advanced cooling therapy, newborn cooling treatment, whole body cooling, and more. The idea behind it is simple. When a newborn is suffering from birth asphyxia, medical professionals will lower the baby’s temperature from the normal 98.6 degrees Fahrenheit to around 92 degrees Fahrenheit.
For maximum results, the temperature is lowered within six hours of delivery and kept there for around 72 hours, according to the University of Oxford4. Specialized devices are used to lower a baby’s body temperature. Examples of devices are cold blankets that circulate cool water around the baby’s body or caps that focus solely on the head.
After the 72 hours, the baby is slowly warmed up to normal temperatures.
How Advanced Cooling Therapy Can Help Prevent HIE
In simplest terms, cooling the brain slows down the processes that cause brain damage.
It is believed that lowering the body’s temperature can reduce the metabolic rate and energy depletion in the brain, decrease functions that cause excitability in the brain, and reduce the death of brain cells caused by low oxygen5.
Some or all of these mechanisms work in concert to prevent brain injury and increase healing before any damage can become permanent.
Efficacy of Newborn Cooling Treatment
Several studies have already confirmed positive outcomes for those treated with hypothermia therapy. In one example from the UK’s National Institute for Health and Clinical Excellence, 10 studies showed the risk of death was lower in babies who had cooling treatment than in those who didn’t6.
Another study from Oxford University and Imperial College London found that more than 50 percent of babies suffering from HIE and treated with brain cooling survived until 6 to 7 years old with a normal IQ4. This was compared to 39.4 percent of those who weren’t treated with brain cooling.
So far, there have been no examples of serious side effects associated with cooling treatment. Only a few cases of skin reactions and slowed heartbeats have been reported.
Brain cooling has become standard care in hospitals around the country. Countless newborns who experience complications during birth could potentially grow up without any brain damage thanks to this treatment option.