Therapeutic Hypothermia for Babies with Hypoxic-Ischemic Encephalopathy (HIE)

Hypoxic-ischemic encephalopathy (HIE) is a type of neonatal brain injury caused by oxygen deprivation at or near the time of birth. It can result in permanent brain damage, lifelong disabilities such as cerebral palsy (CP), and even infant death. However, a cutting-edge treatment called therapeutic hypothermia can minimize the risks associated with HIE.


What Is Hypoxic-Ischemic Encephalopathy (HIE)?

Hypoxic-ischemic encephalopathy (HIE) occurs when the flow of oxygenated blood to a baby’s brain is impeded around the time of birth. This may occur due to complications such as placental abruption, umbilical cord prolapse, or uterine rupture. The initial oxygen-depriving insult is not the only injury; rather, it 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. Therapeutic hypothermia slows down this injury process, allowing the baby’s brain to heal and minimizing the spread of damage.

What is Therapeutic Hypothermia?

Therapeutic hypothermia (also known as hypothermia therapy, cooling therapy, and cooling treatment) 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 damage.

Neonatal therapeutic hypothermia involves cooling the baby to about 33 degrees Celsius (or 91 degrees Fahrenheit) for 72 hours, and then slowly warming them back up.

To administer therapeutic hypothermia, doctors may use either a cooling cap (selective brain cooling) or a cooling blanket (whole body cooling).

During the treatment, neonatal staff also closely monitor 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.

Therapeutic Hypothermia - Brain Cooling - Body Cooling | Treatment for Hypoxic-Ischemic Encephalopathy (HIE)

When Should Doctors Perform Therapeutic Hypothermia?

Guidelines for therapeutic hypothermia continue to evolve as research progresses, and exact criteria vary from hospital to hospital. However, the Academic Medical Center Patient Safety Organization (AMC PSO) provided the following general recommendations from a task force on neonatal encephalopathy in 2016:

Therapeutic hypothermia should be given when all three of the following criteria are met:

  1. The baby is less than six hours of age*, and was born after at least 36 weeks of pregnancy.
  2. At least one of the following:
    • A complication before delivery, such as cord prolapse, uterine rupture, or profound fetal bradycardia
    • An Apgar score of five or lower at 10 minutes of life
    • Prolonged resuscitation at birth
    • Severe acidosis
    • Abnormal base excess within 60 minutes of birth, as shown in umbilical cord gas or neonate blood gas
  3. At least one of the following:

Additionally, physicians are advised to consider administering therapeutic hypothermia when all three of these criteria are met:

  1. The baby is no more than 12 hours of age*, and was born after at least 34 weeks of pregnancy.
  2. At least one of the following:
    • A complication before delivery, such as cord prolapse, uterine rupture, or profound fetal bradycardia
    • An Apgar score of five or lower at 10 minutes of life
    • Prolonged resuscitation at birth
    • Acidosis
    • Abnormal base excess within 60 minutes of birth, as shown in umbilical cord gas or neonate blood gas
    • A collapse after birth that results in hypoxic-ischemic injury.
  3. At least one of the following:
    • Signs of neonatal seizures
    • Evidence of neonatal encephalopathy in a clinical exam

*Recent research indicates that therapeutic hypothermia may still be beneficial when started up to 24 hours after birth.

When Should A Baby Not Receive Therapeutic Hypothermia?

The AMC PSO guidelines state that babies should not receive hypothermia therapy if they were born very preterm (under 34 weeks into pregnancy), and that physicians should exercise extreme caution if they weigh less than 1,750 grams, have severe congenital abnormalities, suffered major intracranial hemorrhage, have overwhelming septicemia, or show evidence for a blood clotting disorder that could make the treatment dangerous.

What Are the Benefits of Therapeutic Hypothermia?Therapeutic hypothermia; Hypothermia therapy; Neonatal Head Cooling; Brain Cooling; Body Cooling; Hypothermia Treatment; Cool Cap

Therapeutic hypothermia offers an alternative to simply relying on the supportive measures that have traditionally been used for babies with HIE.

Research on therapeutic hypothermia has shown that it results in lower rates of death. It also substantially decreases the likelihood that a baby will develop  permanent disabilities such as cerebral palsy, hearing and vision impairments, and developmental delays (all of which can stem from HIE-related brain damage). Although many children given therapeutic hypothermia still do have long-term health consequences from HIE, this treatment can minimize the severity of their conditions.


HIE, Hypothermia Therapy, and Medical Malpractice

Unfortunately, HIE and other birth injuries are often the result of medical malpractice. Examples of negligent actions include the failure to diagnose pregnancy, labor, and delivery complications that can lead to HIE, mismanaging a high-risk pregnancy, delaying a necessary C-section, and committing fetal monitoring errors.

In some cases, medical professionals may also fail to perform or recommend therapeutic hypothermia when it is needed this is malpractice regardless of the initial cause of HIE.

If your child has a disability as the result of HIE, and you believe that the obstetrical staff failed to do everything in their power to prevent this, you may want to consider pursuing a birth injury lawsuit. This can provide your child with the financial resources necessary for therapy, treatment, and a secure future.

Legal Help for HIEBirth Injury Attorneys | Reiter & Walsh, PC | HIE, Birth Asphyxia, Cerebral Palsy, Birth Injury Attorneys

The award-winning birth injury attorneys at Reiter & Walsh ABC Law Centers have helped dozens of children affected by hypoxic-ischemic encephalopathy (HIE).  Partners 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, which has also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation.  

Contact us today to begin your 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 Therapeutic Hypothermia 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.

How Do You Pronounce Hypoxic-Ischemic Encephalopathy?


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Hypoxic-Ischemic Encephalopathy (HIE)

Hypothermia Therapy May Be Effective 6-24 Hours After Birth

Research Update: Combining EPO and Hypothermia Therapy to Treat HIE