It's a parent's worst nightmare: after a normal pregnancy, a healthy baby is born with the umbilical cord wrapped around her neck. Within the first few hours after birth, clearly something is wrong with this otherwise beautiful infant – she is lethargic, not eating, and has had a seizure.
The doctor suspects that she is developing brain damage from a lack of oxygen during birth, a condition known as hypoxic ischemic encephalopathy (HIE). She will be at risk for deafness, mental retardation and cerebral palsy – if she survives. In most hospitals, the treatment for HIE is supportive care and a wait-and-see approach. But UC Davis Children's Hospital Neonatal Intensive Care Unit (NICU) will soon be taking a more proactive approach under the leadership of Ian Griffin, associate professor of pediatrics.
Reducing body temperature
Babies with moderate to severe HIE will be placed on a cooling blanket to lower their body temperatures about six degrees Fahrenheit below normal and will be kept at that temperature for three days before slowly being rewarmed.
Hypothermia therapy, which seems like a treatment borrowed from an episode of Star Trek, is becoming the standard for treating HIE – when it is available.
Soon the UC Davis NICU – a level 3 NICU that offers the highest level of neonatal care – will be the only facility offering it in Northern California, outside of San Francisco.
Proximity to a hospital with this capability is critically important, according to Griffin, because the therapy must begin within six hours after birth to be effective.
Hypothermia treatment not only increases the chance of survival but reduces the likelihood that the baby will develop the disabilities often seen following HIE.
Griffin says that no one can explain exactly why hypothermia treatment works. It is possible that the lower temperature reduces metabolic rate, leading to less energy depletion, swelling and cell death. "The normal responses to stress that are usually protective are probably just too much for a newborn brain to handle," explains Griffin.
Hypothermia treatment also is being explored for other conditions, including for children and adults following an acute brain trauma such as from a car crash or stroke. NFL player Kevin Everett received hypothermia treatment immediately following a spinal cord injury on the field, which may have helped contribute to his recovery.