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Brain Cooling Therapy

Oxygen is essential to the brain. When the brain fails to receive a steady supply of oxygen, it can lead to long-term damage with debilitating side effects. This is particularly true for newborn babies.

Unfortunately, up to 20 in 1000 births1 see some level of brain injury caused by asphyxiation. Until recently, there has been no way to adequately prevent or treat the condition. However, a relatively new treatment option called brain cooling may reduce the incidence of brain damage and death in newborns.

Even though more research needs to be done, brain cooling represents a promising advancement that could prevent countless deaths and severe disabilities.


Newborns & Hypoxic-Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy (HIE), sometimes known as perinatal asphyxia, is a condition in which the brain suffers injury as a result of an inadequate supply of oxygen.

Newborns are particularly susceptible to HIE before, during, and after birth. A lack of oxygen in a newborn can arise in different scenarios. Here is a breakdown of causes before, during, and after birth.

Problems that cause HIE before birth:

  • Insufficient blood flow to the placenta
  • Knots in the umbilical cord
  • Rise in blood pressure
  • Underdeveloped lungs
  • Placental abruption

Problems that cause HIE during birth:

  • Breech
  • Severe maternal hypotension
  • Umbilical cord wrapped around the neck
  • Uterine
  • eruption
  • Difficult labor

Problems that cause HIE after birth:

  • Brain trauma
  • Infections
  • Heart disease
  • Premature birth
  • Low blood
  • pressure

The Dangers of Insufficient Oxygen to the Brain

Even though the brain only accounts for just 2 percent of our body weight, it accounts for up to 20 percent of our intake of oxygen, according to the National Academy of Sciences2. Oxygen is vital to the brain’s functioning and growth. Brain cells like neurons use that oxygen to generate energy. With that energy, neurons allow us to do voluntary actions like thinking and involuntary actions like breathing.

When the brain does not receive oxygen, those brain cells begin to die. The effects begin as early as a minute without oxygen. By three minutes, the brain starts suffering extensive and often irreversible damage. After five minutes, the risk of death increases drastically.

When newborns suffer from a lack of oxygen, the consequences can result in developmental delays, cerebral palsy, cognitive issues, poor motor skills, and more. Some of the symptoms of brain damage caused by oxygen deprivation as a newborn do not reveal themselves until the child is 4 years old.


What is Brain Cooling?

Brain cooling is a relatively new form of treatment to prevent HIE in newborns by lowering the baby’s body and brain temperatures.

The brain or body are cooled to around 92 degrees Fahrenheit using special devices like blankets or caps. The cooling, also known as hypothermia therapy, lasts for around 72 hours before the newborn’s temperature is slowly risen back to the normal 98.6 degrees Fahrenheit.


How Newborn Cooling Treatment Works

By lowering the temperature of the brain or body, scientists have noticed that the functions of the brain slow down. Reducing the rate of energy depletion, metabolism, and inflammation in the brain for three days sometimes prevents the damage from becoming permanent and allows the brain to heal.

Cooling treatment sounds like a radical option, but it is surprisingly effective. In one study3 from Oxford University and Imperial College London, researchers found 51.7 percent of babies deprived of oxygen who were treated with brain cooling lived to 6-7 years with a normal IQ. Only 39.4 percent of babies who received standard care had a normal IQ at that age.

The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom also explored the efficacy of the treatment by looking at studies.

“One study looked at all the results from 10 separate studies with a total of 1320 babies,” NICE wrote in its information sheet on brain cooling4. “Across the 10 studies, the risk of death was lower in the babies who had cooling compared with babies who were treated by standard care.”


Dangers of Advanced Cooling Therapy

Although more studies need to be done on cooling therapy, many scientists say the benefits of the treatment outweigh any risks. One of the most common adverse effects associated with the treatment has to do with skin reactions where cooling materials came in contact with the skin.

Other trials have noted benign sinus bradycardia — a regular but slower heartbeat less than 60 beats per minute — and low blood platelet counts. Neither of these had damaging effects.


The Future of Brain Cooling

Thanks to the promising studies on the benefits of brain cooling, more and more hospitals around the country are beginning to employ the technique to help prevent HIE in newborns. Even though mechanisms for cooling are not available at all hospitals, research suggests that the use of icepacks can be an effective way to provide treatment while the baby awaits transfer to a neonatal intensive care unit (NICU).

The treatment is only available as a preventative method for newborns suffering from a decreased oxygen supply and must be administered within six-hours for best results. This means those already suffering from HIE and its consequences will not benefit.

Unfortunately, treatment does not work for all babies, which is why scientists have begun exploring the use of drugs in combination with cooling treatment to prevent brain damage. Researchers are currently testing whether the hormone erythropoietin could help.

References
  1. UFHealth. "Florida Neonatal Neurologic Network", UFHealth, http://hopefn3.org/research/clinical-research/florida-neonatal-neurologic-network/. Accessed DATE.
  2. Marcus E. Raichle, Debra A. Gusnard. "Appraising the brain's energy budget", PNAS, http://www.pnas.org/content/99/16/10237. Accessed April 30th, 2018.
  3. Source: MRC. "Cooling oxygen-deprived newborns reduces chances of brain damage", University of Oxford, http://www.ox.ac.uk/news/2014-07-10-cooling-oxygen-deprived-newborns-reduces-chances-brain-damage. Accessed April 30th, 2018.
  4. National Institute for Health and Clinical Excellence. "Controlled cooling to treat newborn babies with brain injury caused by oxygen shortage during birth", National Institute for Health and Clinical Excellence, https://www.nice.org.uk/guidance/ipg347/resources/controlled-cooling-to-treat-newborn-babies-with-brain-injury-caused-by-oxygen-shortage-during-birth-pdf-314509357. Accessed April 30th, 2018.
  5. Santina A Zanelli, MD. "Hypoxic-Ischemic Encephalopathy Treatment & Management", Medscape, https://emedicine.medscape.com/article/973501-treatment#d13. Accessed April 30th, 2018.