Neonatal Therapeutic Hypothermia

Neonatal therapeutic hypothermia is a treatment where an infant’s body temperature is gradually reduced to decrease the chances of brain damage following oxygen deprivation at birth. Infants that experience a lack of oxygen or blood flow to the brain during the labor and delivery process may be at increased risk for a brain injury. This type of cooling therapy for newborns slows down the metabolic processes that cause cell death—thus, potentially reducing the severity of the brain damage.

Cooling therapy for newborns is recognized as the standard of care to decrease brain injury in term infants with perinatal hypoxic-ischemic encephalopathy, or HIE. HIE is due to a lack of oxygen or blood flow to the baby’s brain and may cause brain damage. Since the 1960’s, physicians have determined that cooling a baby’s head or body (hypothermia) during the latent phase of the tissue injury could reduce the damage caused by hypoxic-ischemic injury.

When blood flow to the brain is disrupted, severe cellular damage may result. By lowering the body temperature, the demand for oxygen is also lowered. A reduction in brain temperature can slow down or stop the advancement of HIE - decreasing mortality rates and severe disabilities, as well as improving neurodevelopmental outcomes.

Brain hypothermia (HIE cooling) is achieved by placing a water-filled cooling cap fitted around the infant’s head. Total body cooling is achieved by placing fluid-filled blankets or cool packs around the newborn in order to reduce the baby’s body temperature to between 89.6 and 95 degrees and maintaining this temperature without interruption for 72 hours. When the baby’s temperature is brought back up, it is done so very slowly until normal body temperature is achieved. Since some hospitals do not have the ability to provide therapeutic hypothermia, babies in need of the treatment should typically be quickly transferred to a hospital that can provide a higher level of care.

In order for HIE cooling to be most effective, the treatment should be initiated within six hours of birth—this is part of the standard of care for cooling infants with moderate or severe HIE. A new study published in the Journal of the American Medical Association, however, suggests that cooling therapy applied within six to 24 hours after birth may also be effective. By lowering the infant’s body temperature, as discussed above, cells are able to recover and further damage is prevented, thereby decreasing injury severity and permanence of the brain damage. The entire cooling therapy process takes place over the course of three full days.