Hypothermia (Brain Cooling) Treatment for Babies with Hypoxic-Ischemic Encephalopathy (HIE)

One of the newest treatments for babies that experience a lack of oxygen (hypoxic-ischemic encephalopathy, or HIE) during the labor and delivery process is called hypothermia therapy. Hypothermia therapy involves cooling the baby to about 33 degrees Celsius (or 91 degrees Farenheit) for three days following birth. This treatment has been found to significantly improve the outcome of babies with birth-associated HIE by reducing the severity of neurological injury.Therapeutic Hypothermia - Brain Cooling - Body Cooling | Treatment for Hypoxic-Ischemic Encephalopathy (HIE)


What is Hypothermia Therapy?

Hypothermia therapy is a procedure used to help slow down injury processes. While it is now being used in numerous different fields (including for treating heart attacks, strokes, and traumatic injuries in adults), in the context of birth injury, the process focuses specifically on slowing down a baby’s brain injury.

When administering hypothermia therapy, doctors cool down either just the baby’s head or their entire body, which slows down their metabolism. This also slows down the process of brain injury in the baby’s brain. This is very important – whenever a brain injury occurs, there is more damage than just the initial injury. The initial injury sets off a chain reaction: rippling outward from the initial injury site, cells become injured, die, and release certain substances that are toxic to other cells, which in turn become injured. Hypothermia therapy slows down this injury process, allowing the baby’s brain to heal as much as possible from their injury.  However, to be effective, this treatment must be started within six hours* of the oxygen-depriving insult, which often means within six hours of birth.


How Does Hypothermia Therapy Work?

There are two types of hypothermic treatments – selective brain cooling and whole body cooling. In selective brain or head cooling, a cap with channels for circulating cold water is placed on the baby’s head. A machine circulates water through the cap at specific temperatures to ensure moderate cooling of the baby to around 91 degrees F. This is done for 72 hours and then the infant is warmed back to normal temperature over a period of six to eight hours.

 

1. Infant Cooling Cap

By lowering the baby’s temperature, the metabolic rate slows, allowing cell recovery over a longer period of time. This prevents further damage that can occur if normal oxygenation or blood flow is restored too quickly to injured cells.

In addition to watching the baby’s temperature, neonatal staff also closely monitors vital signs like respiration, oxygenation, heart rate, and brain wave activity. Physicians use this data to determine how the baby is responding overall to the cooling treatment.

2. Newborn on Cooling Blanket

In whole body hypothermia, the infant is laid on a cooling blanket, through which circulating cold water is pumped. The desired level of hypothermia is reached quickly and maintained for 72 hours. As with the cooling cap method, the baby is then gradually warmed back up.


When Can Doctors Perform Hypothermia Treatment?

Timing is very important when using hypothermia therapy. The most favorable outcomes are seen when brain cooling is started as soon as possible after the birth injury occurs. Most experts agree that the treatment must be started within six hours to obtain favorable results. The treatment also requires that the newborn is at least 36 weeks gestation and has exhibited at least two of the common signs and symptoms of moderate to severe HIE (e.g. lethargy, stupor, or coma; abnormal tone or posture; abnormal reflexes; decreased/absent spontaneous activity; problems with autonomic dysfunction [bradycardia, abnormal pupils, apnea]; metabolic acidosis; clinical evidence of seizures).


The Benefits of Hypothermia Therapy

Early research on hypothermia therapy showed that two year olds who had received this treatment had better health outcomes. More recently, researchers from the National Institutes of Health followed up with school-aged children who had received hypothermia therapy, and found sustained benefits.

newborn B F wikiSpecifically, death or moderate/severe disability occurred in 44% of the infants who had been given hypothermia and 62% of the control group infants.  The rate of disabling cerebral palsy was 19% in the hypothermia group and 30% in the control group.  The rate of blindness was 7% in the hypothermia group and 14% in the control group.  The rate of hearing impairment was 4% in the hypothermia group and 6% in the control group.

Hypothermic treatment offers an alternative to the supportive measures that have traditionally been used for babies with hypoxic-ischemic encephalopathy.

Despite the favorable results of hypothermia therapy, however, the cause of HIE/birth asphyxia should be carefully examined. In many cases, HIE/birth asphyxia is a direct result of medical errors or negligence, including delayed C-sections; mishandling of uterine ruptures or VBAC (Vaginal Birth after Cesarean); a failure to diagnose umbilical cord problems, like cord compression or prolapse; placental abruption; and fetal monitoring errors.


*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.


Michigan Lawyers Helping Children Affected By Hypoxic-Ischemic Encephalopathy (HIE)

The award-winning birth injury attorneys at Reiter & Walsh ABC Law Centers have helped dozens of children affected by hypoxic-ischemic encephalopathy (HIE).  Attorney Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for his entire career, and most of his cases involve hypoxic-ischemic encephalopathy (HIE) and cerebral palsy.  Michigan HIE lawyers Jesse Reiter and Rebecca Walsh are currently recognized as two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation.  The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ). In fact, Jesse Reiter is one of only 2 attorneys in Michigan to ever be elected Chair of the BTLG.

If your child needed to have hypothermia therapy, was diagnosed with HIE, cerebral palsy, or any other physical or mental disability, there is a good possibility that medical errors and negligence occurred.

Contact Reiter & Walsh, P.C. today to begin your free case review. Free of charge and obligations, we will answer your legal questions, determine the negligent party, and inform you of your legal options. Our team is available to speak with you to set up an appointment in any of the following ways:

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Video: Michigan HIE Lawyers Discuss Hypothermia Treatment and Hypoxic-Ischemic Encephalopathy (HIE)

In this video, Michigan HIE lawyers Jesse Reiter and Rebecca Walsh discuss the causes of and treatments for HIE.  Negligence by the medical team is often the cause of HIE and birth asphyxia.

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