Extending brain cooling in babies may cut disability rate

Brain cooling, a treatment that reduces the rate of disability in newborns, could potentially improve outcomes for more babies.

Consultant paediatrician Deirdre Murray

At the moment, it is given to infants who suffer hypoxic ischemic encephalopathy (HIE), a type of brain damage that occurs when a baby’s brain doesn’t receive enough oxygen and blood. It is administered to those with moderate or severe HIE only, however researchers at University College Cork believe it could also benefit newborns who suffer mild encephalopathy.

Consultant paediatrician Deirdre Murray said they are hoping to now secure funding for a clinical trial to establish if this is the case.

“There’s a lot of interest in the area because it poses a big problem for doctors looking after these babies. For brain cooling to be effective it has to start within the first six hours of life. Time is of the essence. But it can be difficult to decide who to cool and we are probably missing about 20% of those who would benefit,” said Dr Murray, a senior lecturer at UCC.

The problem is compounded for doctors outside of the country’s four cooling centres; Cork University Maternity Hospital (CUMH) and the three Dublin maternity hospitals.

For babies born with moderate brain damage who undergo cooling, follow-up research has shown it decreases the disability rate, the cerebral palsy rate and the death rate. The thinking had been that infants with mild encephalopathy did well anyway, and so didn’t need cooling. However, research led by Dr Murray, published in the journal Paediatrics last year, showed that babies will mild HIE also have lower IQ levels and increased rates of disability at school age.

“They don’t have cerebral palsy and wouldn’t be expected to die, but they showed similar rates of learning disability compared to those with moderate encephalopathy.” Dr Murray, who heads up a UCC research group focused on improving outcomes from early brain injury, said they hope, with other international researchers to establish an international clinical trial to find out whether cooling will benefit babies with mild encephalopathy.

The estimated cost of “cooling” a baby — known as therapeutic hypothermia — is c€4,000, which includes the cost of intensive care. The equipment used resembles a very thin hot water bottle filled with cooling fluid to reduce the baby’s temperature from 37.4C to 33.5C over a 72-hour period. Cooling reduces the rate of disability from about 55%-60% to about 30% in moderate to severe encephalopathy. “We know it works, we just need to find out which babies we should be cooling,” Dr Murray said.

Dr Murray is among an international line-up of experts who will address the ‘Brain Monitoring and Neuroprotection in the Newborn’ conference which gets underway in Killarney today, hosted by INFANT, a world-leading research Centre headed up by UCC.

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