Therapeutic Hypothermia in Newborn

Therapeutic hypothermia is a medical treatment to lower body temperature over a period of 72 hours. After your baby’s temperature is cooled, it will gradually be returned to normal.

This cooling (hypothermia) helps to prevent a type of brain injury that can happen if a baby’s brain does not get enough blood and oxygen (hypoxic ischemia, or neonatal encephalopathy) during birth.

Neonatal encephalopathy can be caused by early separation of the placenta, an umbilical cord that is kinked or wrapped around the baby’s neck, or a tear (rupture) in the uterus.

If encephalopathy is not treated, it can be very dangerous. It can lead to physical and mental disabilities. Cooling your baby within six hours of birth can lower the amount of oxygen that your baby’s brain needs and help to prevent brain injury.

Tell a health care provider about:

• Any pregnancy or childbirth complications.
• Any blood disorders you have or your child has.
• Any medical conditions you have or your child has.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Changes in blood pressure, heart rate, and heart rhythm.
• Loss of ability to form blood clots. This can lead to bleeding.
• Skin damage from a lack of blood getting to the skin.
• Over-cooling.
• Low oxygen levels.
• Changes in blood minerals (electrolytes).
• Kidney damage.
• Low blood sugar (glucose).

What happens before the procedure?

• Your baby will have a physical exam that involves:
  • A routine test to measure health at birth (Apgar score).
  • Checking for signs of moderate or severe encephalopathy.
• Your baby may have tests to determine whether he or she has encephalopathy, and how severe it is. This may involve:
  • An EEG (electroencephalogram). This measures electrical activity in the brain.
  • An MRI. This creates images of the brain.
• After your baby has been diagnosed, the health care providers will determine whether your baby meets certain requirements to benefit safely from this treatment. Your baby must:
  • Have been in the womb for 36 weeks or longer (gestational age).
  • Weigh more than 3.9 lb (1.77 kg).
  • Not have any serious birth defects (congenital anomalies).
  • Be less than 6 hours old.
  • Not have a bleeding problem, such as being unable to form blood clots.

What happens during the procedure?

• One or more of these monitoring devices will be placed:
  • A temperature probe. This will be placed in the rectum or in the part of the body that moves food from the mouth to the stomach (esophagus). The probe will be attached to a monitoring system. If the temperature goes too low, an alarm will make a noise.
  • IV lines in the blood vessels. These will be used during treatment to give fluid and nutrients and to collect blood for testing.
  • Monitors for blood pressure, heart rate, breathing rate, and oxygen level.
  • EEG monitors on the head. These are used to detect any seizure activity.
  • A breathing tube (endotracheal tube), if your baby needs breathing support. This tube will be attached to a breathing machine (respirator). The breathing support may have been started right after birth.
• After all the monitoring devices are in place, cooling will begin. Cooling will start by lowering your baby’s body temperature to about 91.4–95°F (33–35°C), depending on the method used. The method can be:
  • Whole-body cooling. This is done with a cooling blanket or cool packs that are placed around your baby’s body.
  • Head cooling. This is done by placing a cooling cap that circulates cool water on your baby’s head.
• When the temperature is in the target range and stable, it will be kept in that range for 72 hours. During cooling:
  • Your baby’s temperature will be checked every 15 minutes. If your baby’s temperature goes below the target range, cooling will be stopped for 15 minutes. If the temperature continues to fall, your baby may be placed in a warmer.
  • If monitoring suggests a possible complication, cooling may be stopped temporarily until your baby is doing well again. Antiseizure medicine may be given if the EEG suggests any seizure activity.
  • Your baby’s position will be changed every 6 hours.`
  • Your baby will be fed only with IV nutrition.
  • Your baby’s skin will be checked frequently for sensitivity, redness, thickening, or a blue-purple color.
  • Your baby may be given medicine through the IV if he or she seems irritable or restless, which may be a sign of pain or stress. He or she may be given:
    • Pain medicine.
    • Medicine to help him or her relax (sedative).
• After 72 hours, cooling will be stopped and rewarming will begin. The goal of rewarming is to let body temperature gradually return to normal (about 97.7°F or 36.5°C). This takes about 7 hours.
• After the rewarming period, your baby’s blood will be tested to check glucose and oxygen levels, blood clotting, and a complete blood count (CBC).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your baby will continue to be monitored.
• Assisted breathing and IV feeding will be stopped when your baby’s health care provider determines that your baby can safely breathe and eat on his or her own. After this, you may be able to start feeding your baby.

Summary

• Therapeutic hypothermia is a medical treatment to cool a newborn baby’s head or body. This treatment aims to lower your baby’s body temperature for 72 hours.
• Cooling helps to prevent brain injury that may occur if the baby’s brain did not receive enough blood and oxygen during birth (neonatal encephalopathy).
• Before your baby’s temperature is cooled, his or her health care providers will diagnose moderate to severe encephalopathy and make sure that your baby can benefit safely from the cooling treatment.
• Your baby will be monitored carefully during and after this treatment. After 72 hours, your baby will be rewarmed to a normal body temperature.