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Chilling newborns may prevent brain damage

Infants whose brains are starved of oxygen at birth stand a better chance of surviving without damage if their body temperatures are chilled by 6 degrees Fahrenheit for three days, a new study said.
/ Source: Reuters

Infants whose brains are starved of oxygen at birth stand a better chance of surviving without damage if their body temperatures are chilled by 6 degrees Fahrenheit for three days, a new study said Wednesday.

“This is the first treatment that we have to reduce the brain injury in these children,” one of the study’s authors, Seetha Shankaran of Michigan’s Wayne State University, told Reuters.

She estimated that the cooling, which should be initiated within hours after birth, could prevent many cases of death, blindness and other disabilities in the 1,700 full-term infants born in the United States each year whose brains were temporarily cut off from blood or oxygen.

Typically, up to 20 percent of such babies die soon after delivery. Another 25 percent are left disabled.

The findings are “extremely promising, said Duane Alexander, director of the National Institute of Child Health and Human Development, which funded the study.

Technique not ready for use
But the technique is not ready for widespread use. Further tests, including assessments of surviving children when they enter school, are needed to confirm the benefits.

And although the equipment to cool a baby and monitor its temperature costs about $6,000, most hospitals are not set up for the continuous monitoring needed, said Shankaran.

Lu-Ann Papile of the University of New Mexico Health Sciences Center, in an editorial in The New England Journal of Medicine which released the study on Wednesday, agreed that widespread use of brain cooling “would be premature.”

When the brain lacks enough oxygen, it sparks a cascade of harmful chemical reactions that can inflict further damage even after oxygen has been restored. Treatments used by doctors to try to save the baby can also produce toxins, said Shankaran.

Cooling the brain “actually decreases the production of these substances” and gives it time to recover, she said.

Cooling blankets
At 16 medical centers, doctors placed oxygen-deprived, full-term newborns on special blankets infused with cold water to gradually reduce their body temperatures from the normal 98.6F to 92.3F).

After 72 hours, they were allowed to slowly warm.

While 62 percent of the 106 babies in a control group who received standard care died or showed some type of disability two years after birth, the rate was 44 percent among the 102 children whose bodies were chilled.

The rate of disabling cerebral palsy was 63 percent lower with the cooling blanket, the rate of blindness was 50 percent lower, and the death rate was 32 percent lower.

But one of the study’s authors, Abbot Laptook of Women & Infants Hospital in Rhode Island, cautioned that most hospitals are ill-equipped to rapidly recognize infants who might benefit from the treatment and then provide it within six hours of birth, and that “these are very sick babies who have many ongoing medical issues, of which controlling their temperature is just one.”

“There is the opportunity for harm if you don’t know what to look for and if (the equipment) is not used properly.”

Laptook said it is uncertain if the treatment would help babies born prematurely.

One reason, he said, is that “premature infants have many other problems related to prematurity. The one we deal with most often is disorders of lung development, and dropping body temperature can have an adverse effect on the lungs.”