Therapeutic Hypothermia - Time-sensitive treatment reduces injury to newborns lacking oxygen to the brain

Hypoxic-ischemic encephalopathy or brain injury caused by oxygen depravation to the brain due to fetal or neonatal asphyxia is a leading cause of death or severe impairment among infants.

These impairments include epilepsy, developmental delay, motor impairment, neurodevelopmental delay and cognitive impairment, and the severity is not usually determined until the child is about three to four years old.

Therapeutic hypothermia has been shown to be a useful therapeutic modality in the treatment of term and late preterm newborns with neonatal hypoxic-ischemic encephalopathy.

This therapy is time-sensitive with initiation recommended within six hours of birth. Active cooling of either the head or entire body is performed with a target temperature of

33-348C for a duration of 72 hours.

Major clinical trials have demonstrated a reduction in both death and major disability in treated infants. While delivery facilities without this treatment modality should passively cool qualifying infants awaiting transport to a facility offering this service, recent advances in equipment now allow active servo controlled cooling by the transport team en route to the receiving institution, explained Dr Lester A. McIntyre, board-certified in paediatrics and neonatal-perinatal medicine from Joe DiMaggio Children's Hospital of Memorial Healthcare System of South Florida.

ELIMINATE ASPHYXIA DURING PREGNANCY

Due to the fact that asphyxia typically causes permanent damage, which sometimes continues to progress even after the asphyxia has been relieved, treatment for hypoxic-ischemic encephalopathy focuses on helping the child adapt to symptoms that result from the brain injury.

"Some promising neuroprotective agents currently under investigation as adjunctive therapy include erythropoietin, melatonin, inhaled argon and xenon, allopurinol and stem cells," McIntyre said.

The best way to prevent hypoxic-ischemic encephalopathy is to eliminate asphyxia during pregnancy and delivery. Awareness of hypoxic-encephalopathy risk factors can help parents and medical personnel prevent and prepare for possible complications.

At the Memorial Neonatal Intensive Care Unit, multidisciplinary care, coupled with patient and family-centred care approach is provided, and every one of the team members strives to provide each patient with their best care.