What criteria do doctors use to decide whether a baby should get hypothermia therapy?

There are many criteria that physicians use to determine whether a baby should get hypothermia therapy (brain cooling). Medical professionals first must determine if an infant has hypoxic-ischemic encephalopathy (HIE). This is very important, as medical staff will only provide hypothermia treatment if there is an HIE diagnosis. If medical professionals fail to quickly diagnose HIE, the baby may not receive treatment within the crucial 6 hours* after the injury. This means that time is of the essence when HIE is suspected.

Medical staff must monitor newborns for signs and symptoms of HIE

There are certain clues or indicators that indicate that a baby may have HIE. These include:

  • Baby needed resuscitation at birth or during the first few days of life
  • Low APGAR scores for more than 5 minutes
  • Seizures within 24-48 hours of delivery, in the NICU, or shortly after discharge from the NICU
  • Difficulty feeding
  • Profound metabolic or mixed acidemia in umbilical cord blood samples
  • Multiple organ issues
  • No brainstem reflexes (breathing issues, abnormal responses to light, or lack of reflexes other than blood pressure and heart function)
  • Coma
  • Hypotonia or abnormal limpness

If these are present, medical staff may conduct further evaluations and assess hypothermia therapy eligibility criteria.

Hospitals often use the same eligibility criteria as research trials when determining whether to give babies hypothermia therapy (cooling therapy)

Whether or not physicians will administer hypothermia therapy depends on numerous criteria, though criteria can also vary from hospital to hospital.

The clinical trial criteria many hospitals may reference include:

  • Gestational age 36 weeks+
  • pH<7 OR base deficit ≥ 16 in umbilical cord arterial sample
    • If the baby’s pH is greater than 7 (7.01-7.15), the base deficit must be 10-15.9.
    • If blood gas samples aren’t available, physicians look for alternative criteria:
      • Evidence of seizures or neonatal encephalopathy from a standard neurological exam
      • The presence of sudden events during labor. These can include:
        • Non-reassuring fetal heart tones
        • Umbilical cord prolapse/rupture
        • Uterine rupture
        • Maternal trauma
        • Hemorrhage
        • Cardiorespiratory arrest
        • However, the presence of these events alone is not enough. These events must be present along with either:
          • A 10-minute APGAR score of 5 or less or
          • Assisted ventilation that lasts 10 or more minutes

These are, of course, general guidelines. The American Academy of Pediatrics (Virginia Chapter) uses the following guidelines:

Criteria A:

  1. The infant is 35+ weeks gestation and has at least one of the following criteria:
    1. APGAR score under 5 (10 minutes after birth)
    2. Continued need for resuscitation (10 minutes after birth)
    3. Acidosis (umbilical cord or arterial pH under 7.00) within 60 min. of birth
    4. Base Deficit > 16 mmol/L (any blood sample) within 60 min of birth

If the infant meets criteria A, physicians can then move on to assessing neurological abnormality:

  1. Moderate to severe encephalopathy (Sarnat Stage II or III) with altered consciousness (lethargy, stupor, or coma), along with at least one of the following:
    1. Hypotonia
    2. Abnormal reflexes
    3. Absent or weak sucking

If a baby meets the criteria above, then they should receive hypothermia treatment. 

This said, if a child is diagnosed with HIE (even if they don’t meet all of the criteria), physicians should provide hypothermia therapy, so long as the following requirements are met:

  • Baby born at 36+ weeks (35+ weeks in some locations)
  • The oxygen-depriving insult occurred within 6 hours
  • There are no contraindications to hypothermia treatment

*Research Update: Hypothermia Therapy May Be Effective 6-24 Hours After Birth

A recently-published study in the Journal of the American Medical Association (JAMA) suggests that hypothermia therapy may be effective 6-24 hours after birth. Laptook et al. (2017) conducted a randomized clinical trial of infants with moderate or severe HIE. 83 infants were given hypothermia therapy, while 85 were maintained at a normal body temperature (control group). The authors then followed up with these cohorts between 18 and 22 months of age. Their results were non-significant under traditional frequentist analysis, but they suggested that hypothermia therapy may still be helpful more than six hours after birth. Laptook et al. stress that further research is warranted, because an improved prognosis in even a small percentage of patients could be of clinical importance due to the severity of HIE-related brain damage. Moreover, they found “no evidence of commensurate harm” – in other words, the potential benefits of administering hypothermia therapy between 6-24 hours may outweigh the costs.


Talk to Our Trusted Hypoxic Ischemic Encephalopathy Attorneys for Legal Help

The attorneys at Reiter & Walsh P.C. focus only on birth injuries — we are one of the few firms in the nation that does, and have a particular focus on hypoxic-ischemic encephalopathy and cooling therapy. This narrow focus has allowed us to develop an extensive knowledge of both the medical and legal aspects of birth injury law, amassing a long track record of successes in representing our clients. If you believe your baby needed hypothermia therapy and did not receive it, or needed brain cooling due to a medical staffer’s mistake, reach out to the birth trauma professionals at Reiter & Walsh P.C. to receive a free case evaluation.

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