NEWARK–The Neonatal Intensive Care Unit (NICU) at Children’s Hospital of New Jersey (CHoNJ) continues to be at the forefront of a relatively new technology called therapeutic hypothermia which is used to treat oxygen-deprived newborns. Therapeutic hypothermia is the deliberate lowering of the body temperature to stop further inflammatory reaction in the brain and prevent brain injury.
In 2008, the NICU at CHoNJ became the first in the state to use therapeutic hypothermia on an infant, and since then the NICU team has successfully used the therapy on 39 infants.
The first patient, a full term boy who had been deprived of oxygen, was transferred to CHoNJ where he received the therapy to cool the brain. After the treatment, the baby tested as completely normal in function and had a full recovery.
“Overall this seems to be a very valuable treatment,” reports Morris Cohen, M.D., Director of Neonatal Medicine at CHNJ. “These are babies who would normally end up with many health problems and for the most part, after treatment, they do not.”
The therapy uses a specially designed blanket, called the “Blanketrol® III Hyper-Hypothermia System,” with an electronically controlled cooling system that reduces a baby’s body temperature to 92.8 degrees for 72 hours. Cooling the brain slows down the metabolism, providing time for the neurons that have been deprived of oxygen to recover. The cooling technology stops the inflammatory reaction that would continue to cause further damage even 12 to 24 hours after the event where oxygen was deprived.
“In the same way that cold water is used to cool a burn and limit the damage, cooling the brain stops the inflammatory reaction from continuing and prevents further injury,” says Dr. Cohen.
During the treatment, an infant’s temperature is measured throughout to ensure that the right amount of cooling and all vital functions are carefully monitored. After 72-hours, the baby’s temperature is gradually returned to normal and an EEG and MRI are performed to access recovery.
The most common patients are full term or near term infants who are deprived of oxygen during the final phase of pregnancy or during delivery often due to placenta abruption, the separation of the placenta from its attachment to the uterus wall before the baby is delivered.
Research has shown that cooling a newborn for three days on a temperature-controlled blanket can help to prevent or reduce brain damage caused by lack of oxygen during difficult births. Newborns with that complication die more often or face mental and physical disabilities, including cerebral palsy, mental retardation, and blindness.
A study in the New England Journal of Medicine, October 2009, found that this technology provides hope for babies deprived of oxygen if applied with-in the first six hours of life.
Reduced body temperature has been used successfully in other areas of medicine for years. Managed hypothermia can reduce long-term neurological damage after sudden cardiac arrest, after stroke, and following a spine or head trauma. Early treatment appears to be essential to recovery when using this technique.
“It is very important to get these babies early, within a six hour window, to slow down further brain damage,” says Dr. Cohen. “We assemble an entire team immediately and get the equipment in place as soon as possible for the best outcome.”
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