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Brain cooling treatment for babies with brain injury

In recent years the ‘cooling’ of babies has become a mainstay of treatment for infants who have suffered from a brain injury due to asphyxia (lack of oxygen), at the time of their birth. The process of cooling the baby can reduce the level of damage to their brains by altering the chemical processes that lead to permanent brain damage.

In spring of this year, scientists from Norway, Slovenia, Germany and a lot closer to home in Bristol, published research in to the optimal temperature for cooling [1]. I have just finished reading the scientists’ publication of their research and this blog summarises what they found.

What is perinatal asphyxia?

According to the publication, perinatal asphyxia (or hypoxic ischaemic encephalopathy) is one of the leading causes of death in newborn babies. Babies who survive asphyxia around the time of their birth are likely to suffer from ongoing disabilities such as cerebral palsy or epilepsy.

At all stages of life, the brain has enormous energy demands. Most of the energy is produced from a chemical reaction involving sugar (glucose) and oxygen. Oxygen and glucose are transported to the brain via blood circulating around the body. A drop in blood oxygen (hypoxia); a drop in blood glucose (hypoglycaemia); and/or a disruption in blood flow (ischaemia) can all result in energy deprivation. The term ‘hypoxic-ischaemic encephalopathy’ describes a brain injury caused by any combination of the above around the time of a baby’s birth.

What is therapeutic cooling and how does it reduce brain damage?

Once the brain is deprived of energy, a series of chemical processes occur within the brain to cause permanent damage. By cooling a baby’s brain, these chemical processes can be altered and as a result, the amount of brain damage can sometimes be reduced.

Normal body temperature lies around 37 degrees and I understand that the current standard of care involves cooling a baby down to 32-35 degrees for three full days. The baby is cooled by a cold blanket or mattress. After 3 days the baby is gradually warmed up again.

What did the recent research involve and what were the results?

The critical question which the scientists carrying out the research attempted to answer is whether greater or more prolonged cooling offered greater protection against brain damage.

The experiment involved cooling baby rats, who had experienced brain injury, to 5 different cooling temperatures. The results of the research revealed that cooling below 33.5 degrees did not provide additional brain protection.

As a lawyer acting for children who suffer from brain injuries around the time of their birth and seeing the lifelong effects of such injuries on the children and their families, I hope that the results of this research will be used to improve the treatment for babies who have suffered from hypoxic ischaemic brain injury at the time of their births.

[1] Treatment temperature and insult severity influence the neuroprotective effects of therapeutic hypothermia. Wood et al. Sci Rep 2016; 6:23430


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