Hypoxic Ischemic Encephalopathy and Cooling Therapy: What Parents Need to Know

Newborn babies who have suffered oxygen deprivation and limited blood flow may experience a type of brain damage called hypoxic-ischemic encephalopathy (HIE). This birth injury is sometimes also called fetal hypoxia, neonatal encephalopathy, birth asphyxia, or perinatal asphyxia.

As frightening as this diagnosis sounds, there is therapy that can minimize permanent brain damage, and in some cases prevent it altogether. This treatment, called hypothermia therapy (or cooling therapy, therapeutic hypothermia, or neonatal cooling) involves significantly cooling the newborn to allow the brain time to recover from the birth injury.

Hypothermia therapy emerged as a result of doctors’ observations over time that patients whose body temperatures were very low suffered fewer long-term negative effects from some injuries than might have been expected in a warmer patient. A classic example is a child who falls through thin ice and is submerged in very cold water for minutes, yet makes a full recovery. The mechanism by which cooling works to prevent injury is unclear, but doctors theorize that cooling slows biological processes and the progression of damage to the brain. This extends the time frame in which treatment can be successfully administered.

However, in order to be effective, therapeutic hypothermia must be induced as soon as possible after the baby was deprived of oxygen and blood flow. While it was previously thought that treatment needed to be administered within six hours, or twelve in limited circumstances, more recent research indicates that beginning the cooling process within 24 hours may have some beneficial effect. That said, it is best to begin treatment as soon as possible, preferably within six hours and ideally immediately after birth.

How Does Hypothermia Therapy Work?

Cooling therapy is given by one of two means: whole-body cooling, in which the baby’s entire body is cooled, or through a “cooling cap” that administers selective cooling to the brain area. Most hospitals have protocols in place regarding which therapy to use; some hospitals may only have equipment to administer one type of cooling or the other, but both are known to be effective.

During the cooling process, medical professionals try to reduce the baby’s body temperature to about 92.3 degrees Fahrenheit (33.5 degrees Celsius). This significantly cooled body temperature lowers the body’s metabolic rate, giving the baby’s cells an opportunity to recover from the brain injury. Typically, the baby is cooled for about 72 hours.

When Should a Baby Have Hypothermia Therapy?

As a general rule, therapeutic hypothermia is called for when one or more of the following criteria are present: there was a birth injury or complication that deprived the baby of oxygen; the baby needed prolonged resuscitation efforts; the baby’s body fluids contain too much acid (acidosis); an umbilical or neonatal blood gas test yielded an abnormal result; abnormal pupillary reflex; or the baby had an Apgar score of five or lower at ten minutes after birth. The baby must also have displayed clinical signs of brain damage or seizure activity.

In some cases that do not clearly call for therapeutic cooling, doctors may also consider administering the therapy out of an abundance of caution. Because the effects of HIE are often not apparent for many months, it may be advisable to administer cooling therapy in borderline cases. Many hospitals that offer the treatment will not administer cooling therapy to infants who are born at less than 36 weeks gestation.

Treatment During and After Hypothermia Therapy

As you can imagine, the process of administering hypothermia therapy is a delicate one that must be undertaken with great care. The baby must be appropriately sedated, and monitored for acidosis, blood gas levels, and seizure activity. Glucose and electrolyte levels must be monitored and maintained. If needed, respiratory and cardiovascular support will be offered, and the baby will be screened and treated for any infections that might develop.

Re-warming the baby at the conclusion of therapy must also be done carefully. When blood flow to the brain is restored too quickly, something called “reperfusion injury” can take place. Restoring circulation can lead to inflammation and other issues if done too rapidly, and can make damage to brain tissue even worse.

Therefore, the baby’s temperature needs to be increased very gradually to 97.7 degrees Fahrenheit (36.5 Celsius). The medical team may also consider monitoring the baby for seizure activity during this process, during which the risk of seizures is elevated.

Cooling Therapy and Medical Malpractice

The window in which to administer hypothermia therapy is brief, and the potential consequences if HIE goes untreated are severe. Therefore, failure to recognize HIE and treat it with cooling therapy may constitute medical malpractice. (The circumstances which led to the baby being deprived of oxygen may, themselves, involve medical malpractice).

Even with therapeutic treatment, children with HIE may require a lifetime of care. Medical professionals whose actions led to the child’s injury, or failed to properly treat it, may have some liability. Consult an experienced Oregon medical malpractice attorney to discuss your child’s situation and whether you may be entitled to compensation to help pay for their ongoing needs.