Neonatal cooling to reduce impact of peri-natal oxygen deprivation

Posted: 28/01/2014

The cooling of babies, who are suspected to have suffered oxygen deprivation during the course of their births, is becoming a standard treatment in the UK.

In 2010, the National Institute for Health and Care (formerly Clinical) Excellence (NICE) issued a press release indicating that the cooling of babies, properly termed therapeutic hypothermia, was both ‘safe and effective’ enough for NHS use and it issued guidance for its use in the NHS, setting out when it should be used to treat vulnerable babies.

It is estimated, by NICE, that every year more than 1000 otherwise healthy babies are born at full term in the UK who either die or suffer brain damage, leading to permanent conditions such as cerebral palsy, as a result of a lack of oxygen during labour or at birth.

The rationale behind the cooling treatment is that lowering the baby’s temperature and, in particular, the temperature of the brain reduces the release of toxic substances from the cells of the brain, caused by a period of oxygen deprivation, thereby reducing the impact of such deprivation and reducing the extent or development of permanent brain damage.

It was because the research in this area was so convincing, in terms of evidencing the benefits of such treatment, that NICE issued the guidelines.

In practice, the baby is cooled, using a special suit, blanket or mattress, for a period of 72 hours, with the baby’s temperature being reduced to approximately 33° C. The baby’s intracorporeal temperature is monitored carefully. After 72 hours or, on occasions, a longer period of time, the baby’s temperature is carefully increased again.

Sometimes the cooling therapy is combined with the use of a gas, such as Xenon, which may offer membrane protection, although this is an expensive treatment.

With convincing research evidencing the benefits of neonatal cooling, an institution that fails to offer this treatment to a vulnerable baby, who meets the criteria, or to refer the baby to another neonatal unit that can provide such therapy is likely to be open to criticism.

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