Therapeutic hypothermia, or cooling therapy, is a treatment that can help reduce brain damage in newborns who suffer from oxygen deprivation at birth. A lack of oxygen to the baby’s brain can cause hypoxic-ischemic encephalopathy, or HIE, a significant cause of infant mortality and neurodevelopmental deficits (damage to the brain). In developed countries, neonatal HIE occurs in about 1.5 per 1000 live births.
Cooling therapy slows the brain’s metabolism to reduce damage. It is currently the only therapy shown to reduce brain damage. If started in the first six hours of life, cooling therapy can increase the chance of survival and lessen disability in newborns with moderate to severe HIE.
Why is Cooling Therapy Used for Newborns?
Infants can suffer from severe oxygen deficiency like HIE or birth asphyxia due to complications like fetal distress, blood loss, placental abruption, uterine rupture, umbilical cord prolapse, or amniotic fluid embolism. In such cases, it’s crucial to start cooling therapy immediately. When the brain doesn’t have enough oxygen it can be damaged and it produces damaging toxic chemicals.
According to the University of Florida, cooling therapy helps approximately one in eight babies with moderate to severe HIE and is proven to reduce the risk of long-term neurodevelopmental handicaps. Survivors of HIE often develop conditions like cerebral palsy, cognitive impairments, hearing and vision loss, and learning disabilities later in life, but cooling therapy may reduce the extent of the damage to the brain and lessens long-term disabilities.
“Cooling treatments is something that has been a phenomenon probably over approximately the past 15 or 20 years. And what happens is these children that are born with a hypoxic brain injury oftentimes are transported to a level one NICU center that has cooling. The general hypothesis is that the cooling will lessen or decrease the oxygen deprivation injury that occurs. And we’ve seen that happen with many of the children that we have represented.”
Is Cooling a Cure for HIE?
Cooling therapy is considered can help to reduce damage. In cases of significant HIE it is generally not considered to be a cure.
How is Cooling Done?
Cooling therapy aims to lower an infant’s body temperature by three to four degrees to about 92 degrees Fahrenheit for 72 hours. This can be done in one of two ways: whole-body or selective head cooling.
Whole-Body Cooling
Whole-body cooling involves covering infants in a special blanket that circulates water to uniformly cool their entire body. Some studies have found that whole-body cooling offers better neuroprotection than selective head cooling, though the two methods are generally similar in safety, effectiveness, and side effects. Whole-body cooling is preferred to head cooling in most of the U.S., especially because it provides better access to the infant’s scalp for EEG monitoring.
Selective Head Cooling
Selective head cooling involves placing a head cap that circulates cold water on an infant’s head to decrease the core temperature. In a 2024 study, researchers found that head cooling can safely improve survival rates by about 10 percent without causing a severe neurodevelopmental disability.
Passive Cooling Techniques
Passive cooling is a practice that can be used temporarily in facilities without immediate access to specialized cooling equipment until the newborn can be transferred to a cooling facility. The practice involves turning off the warmer on the baby’s incubator, removing the baby’s clothes, and not covering the baby in a blanket to cool the baby off slightly.
What Are the Risks and Side Effects of Cooling Therapy?
Cooling therapy is usually well-tolerated by newborns, though short-term side effects are common. Some side effects newborns may experience during or after cooling therapy include the following:
- Reduced heart rate
- Hypotension
- Arrhythmia
- Pulmonary hypertension
- Decreased oxygen delivery
- Electrolyte imbalance
- Platelet dysfunction
- Sepsis
- Delayed gastric emptying
- Seizures
- Apnea
Infants with HIE or other oxygen deprivation-related conditions must be closely monitored by specialized neonatal care teams. Cooling therapy involves critical time-sensitive management and the collaboration of an interprofessional team of health care workers. The bedside nurse must monitor newborns at all times for the early detection and management of complications.
Who is Eligible for Cooling Therapy?
When a baby is suffering from oxygen deprivation after birth, it’s critical to provide immediate medical intervention to maximize the effectiveness of the therapy and improve the infant’s outcome. To qualify for cooling therapy, an infant typically must meet the following criteria:
- Born after 36 weeks of gestation or more
- Weighs more than 1800 grams at birth
- Is less than six hours old
- Exhibits symptoms of oxygen deprivation
- Is suffering from moderate to severe encephalopathy
Some more specific examination criteria may apply depending on the situation.
Though parents of all term newborns with moderate to severe HIE should be offered cooling therapy, it does not benefit certain newborns. An infant may be excluded from cooling therapy if any of the following criteria apply:
- Premature birth, which is less than 36 weeks of gestation
- Birth weight less than 1800 grams
- Older than 6 hours of age, though some physicians consider cooling therapy for infants up to 24 hours after birth
- Significant congenital abnormality
- Death appears inevitable
- Head trauma or skull fracture
- Mild HIE
How Can a FHVG Florida Birth Injury Attorney Help?
If cooling therapy was offered or administered properly to your child, the underlying oxygen deprivation that occurred during or before childbirth might have been preventable and the result of medical malpractice. You may be eligible to file a medical malpractice lawsuit for the lifetime of care that a child with HIE often requires. Get the answers you deserve. A birth injury attorney can help your family navigate the complexities of medical malpractice claims to seek justice and compensation.
At Freedland Harwin Valori Gander, our attorneys have worked for more than 20 years to protect the rights of medical malpractice victims in Florida and across the country. Our team is passionate and aggressive and will employ all available resources to ensure you receive the maximum possible recovery in an ethical way.
At FHVG, we’re dedicated to going up against major insurance companies, pharmaceutical companies, and hospital systems to pursue justice. We’ve recovered over $2.6 billion for our clients, providing them care, compassion, and communication throughout the entire process.
For a free case evaluation, contact our birth injury lawyers today by calling 954-467-6400 or filling out our online contact form.
