Neonatal Therapeutic Hypothermia

Neonatal therapeutic hypothermia is a relatively new treatment option in which an infant’s total body temperature is reduced shortly after birth in order to reduce the chances of severe brain damage and slow down disease progression. While additional studies and research are ongoing, many medical experts are advocates for this type of treatment and feel the benefits greatly outweigh any risks.

How Does Neonatal Therapeutic Hypothermia Help Infants?

Past research indicates that when people are injured, they have healed easier if they were hurt while cold or in extremely cold weather. Based upon past studies and research, scientists and physicians came up with the idea to place injured newborns into a clinical treatment setting in which their bodies temperatures are lowered. Since brain cells begin to die within minutes of losing oxygen, it’s important that treatment begin immediately.

According to the National Institutes of Health (NIH), neonatal hypoxic-ischemic encephalopathy (HIE) occurs in around 1 to 6 out of every 1,000 births. HIE is defined as lack of oxygen to the brain, and without immediate treatment, infants are at risk not only of severe brain damage, but death as well. In fact, NIH states that around 15-20% of newborns who develop HIE will die. Many infants with HIE are candidates for neonatal therapeutic hypothermia. During the process, they are placed in a clinical setting in which the temperature is around 33 °C. Treatment generally lasts around three days.

The type of clinical setting used will depend upon the infant’s injuries as well as the available resources at the hospital. In most instances, however, babies are placed on a cooling blanket that’s filled with water. They are monitored over the next several days while their metabolic processes slow down. If resources are not available, the infant may be transferred to a hospital with better equipment. While being transported, the baby may be given an IV to help reduce body temperature.

Expert Opinions on Neonatal Therapeutic Hypothermia

Although there still aren’t definitive answers on how well neonatal therapeutic hypothermia works on all injured newborns, clinical trials have been promising, and many experts feel that it should become standard treatment care for infants who are deprived of oxygen.

“We have found that therapeutic hypothermia can reduce the chance of severe brain injury by 25 percent in term-born babies with poor transition or low Apgar scores after birth,” said Dr. Inder of Washington University School of Medicine. “It is very important that these babies are referred to us as soon as possible because it appears this treatment may not work as well after the first few hours of life.”

Dr. Seetha Shankaran, division director of neonatal and perinatal medicine for the DMC Children’s Hospital of Michigan is also an advocate of neonatal therapeutic hypothermia. As the lead director of a study on neonatal therapeutic hypothermia, Dr. Shankaran states that there were many benefits and that treatment could mean many infants can be saved from developing cerebral palsy and other debilitating conditions caused by brain damage.

“I don’t think there’s any doubt that these findings will have a significant impact on the medical treatment of newborns who experience oxygen deprivation at birth,” said Dr. Shankaran. “This is a very hopeful breakthrough for all of us who work in the field of neonatal medicine.”

Signs that Neonatal Therapeutic Hypothermia May Be Needed

In most cases, physicians will do all that they can to ensure a baby is as healthy as possible. However, there are certain signs that indicate that an infant may be at risk for oxygen loss, including:

  • Fetal heart abnormalities
  • Meconium in the amniotic fluid
  • A difficult delivery
  • An infant too large or too small for gestational age
  • Lack of oxygen in the mother’s blood before birth
  • A delayed C-section
  • Umbilical cord problems during delivery
  • Maternal preeclampsia
  • Fetal anemia
  • Premature birth

Are There Any Risk Factors Associated with Neonatal Therapeutic Hypothermia?

Research indicates that so far, the benefits of neonatal therapeutic hypothermia outweigh the risks involved. However, it’s important to understand that there may be certain risk factors involved. For instance, according to the WHO Reproductive Health Library (RHL), some studies show a slightly increased baseline heart rate in infants undergoing treatment, as well as an increased need for blood pressure support.

Neonatal therapeutic hypothermia doesn’t seem to help infants with seizures during the treatment period, which can be common in those who experience oxygen deprivation. Other studies indicated that coagulation (blood clotting) may occur, but this is normally if the infant was already experiencing it before the treatment began.

Criteria For Neonatal Therapeutic Hypothermia

In most instances, babies must qualify for neonatal therapeutic hypothermia treatment, which many include the following:

  • An apgar score of <5 after 10 minutes of birth
  • Need for resuscitation and oxygen after 10 minutes of birth
  • Infants born 36 weeks gestation and older
  • Infants with moderate to severe encephalopathy (abnormal brain functions)

Long Term Benefits of Neonatal Therapeutic Hypothermia

According to NIH, there are quite a few long-term benefits to neonatal therapeutic hypothermia. For instance, children who underwent treatment as infants were more likely to have a higher survival rate at 6-7 years of age. In addition, infants who received the treatment were less likely to develop severe developmental issues such a hearing loss, vision loss, and cognitive impairments. Furthermore, the rate of infant death declines with those receive neonatal therapeutic hypothermia treatment.

“Before the advent of this cooling treatment in 2005, doctors couldn’t treat HIE, and many infants died or sustained brain injury,” said Dr. Shankaran.“It’s reassuring to see that the benefits of this practice, which have been widely documented at 18 months or 2 years of age, are apparent as these children grow.”

Additional Information on Neonatal Therapeutic Hypothermia

If you’re experiencing a difficult pregnancy, it’s important to discuss the possibility of neonatal therapeutic hypothermia with your physician. This is not to say that all difficult pregnancies will result in infant brain damage, yet, it’s always a good idea to be prepared and understand how treatment works.

Currently, there is no other effective type of treatment for severe infant brain damage, yet more studies and trials are needed before neonatal therapeutic hypothermia becomes a standard treatment option.