Infants continue to suffer brain damage during childbirth at alarming rates. Birth asphyxia is a particularly pressing cause of long-term neurological disorders in infants and children, according to pediatricians at Duke University. In fact, episodes of oxygen deprivation, both brief and prolonged, may lead to brain damage in between 2 and 6 out of every 1,000 live births.
Can Hypothermia Therapy Save Children From Long-Term Brain Damage?
When left untreated, the effects of birth asphyxia can be deadly. Children who survive oxygen deprivation, on the other hand, often develop hypoxic-ischemic encephalopathy, a form of brain damage that can lead to severe neurological impairments. But as recently as 2005, doctors had not identified any specific therapy to treat this devastating cause of death and disability, according to a team of UK researchers writing in the British Medical Journal.
A radical new treatment method, which has been shown to reduce death and disability in children with neonatal brain damage, may be changing this situation for the better. The treatment is known as therapeutic hypothermia, or targeted temperature management. By intentionally cooling an infant’s body temperature, doctors have been able to reduce the extent of brain damage and improve neurological outcomes in children up to 18 months after birth.
While major questions remain around the technique’s long-term safety and efficacy, therapeutic hypothermia has gone from being a largely-unproven concept to the developed world’s “standard treatment” for hypoxic-ischemic encephalopathy, as researchers from India to Spain have found.
How Does Therapeutic Hypothermia Work?
The brain damage that can be caused by oxygen deprivation does not happen instantaneously. In a British Medical Journal article published in 2010, researchers from England, New Zealand and Northern Ireland explain that neural damage resulting from birth asphyxia “is delayed for several hours.” This delay creates a brief window during which effective treatment can be administered.
In 2013, a large review of clinical evidence published by the Cochrane Library found that therapeutic cooling reduced mortality, without increasing the rate of major disability, among hypoxic-ischemic encephalopathy survivors. Even more promising, benefits from cooling were observed in children up to 18 months of age.
As a clinical guideline, the researchers advised doctors to administer a full 72 hours of moderate hypothermic therapy, beginning within the first six hours of a child’s delivery. Most studies suggest that lowering an infant’s body temperature by 37° to 41°F provides optimal results, doctors from the Total Body Hypothermia Study Group report.
Surprisingly, hypothermia treatment is an ancient practice. As neurologists at California’s Cedars-Sinai Medical Center note, Hippocrates, the “father of modern medicine,” described in 400 BCE the beneficial impact of snow and ice on patients who experienced significant blood loss. In modern times, the technique came to prominence in 2002, after two landmark clinical studies in the New England Journal of Medicine found that cooling the body increased survival and reduced neurological damage after cardiac arrest. Research into the treatment’s potential benefits for infant patients began soon after.
Despite promising results, doctors have been hesitant to endorse hypothermic therapy. The treatment presents its own short-term side effects, including bradycardia, a significant decrease in heart rate, and thrombocytopenia, a reduction of platelets in the blood. Despite these reservations, most researchers, including those at the Cochrane Library, suggest that the technique’s potential benefits outweigh its risks.
Clinicians, however, have been advised to approach hypothermia treatment with caution. In 2005, a working group convened by the National Institute of Child Health and Human Development identified therapeutic hypothermia as a promising area of research, but fell short of advocating for the technique as a new standard of care. The experts showed particular concern over a lack of long-term data on the therapy’s safety and efficacy. Likewise, a 2005 report from the American Academy of Pediatrics suggested that implementing hypothermia treatment as a standard of care on the national level would be premature. More recent publications, like the American Academy of Pediatrics‘ 2014 statement on the subject, suggest that widespread implementation may lie in the future.
The benefits of hypothermia therapy have not yet been substantiated in premature babies born before 35 weeks of gestation. Nor has it been suggested as an appropriate treatment for children with mild forms of brain damage. The majority of researchers, including the experts at the American Academy of Pediatricians, currently believe that hypothermia is suitable only for children with moderate to severe brain injuries.