Hospital cools brains of newborns to fight injury

[Xavier]

California Valley hospital cools brains of newborns to fight injury.

California - Newborn Johnnathen Rivas Jr. was in trouble. His brain had been cut off from oxygen and was beginning to swell after his birth Wednesday at Tulare Regional Medical Center.

An innovative therapy that cools a baby’s body could decrease Johnnathen’s brain injury. But it had to be done quickly to stop the damage — doctors had six hours to drop Johnnathen’s body temperature about 6 degrees below normal, to 92.3 degrees.

Only three days earlier, Children’s Hospital Central California had just installed the Valley’s first whole-body cooling blanket for newborns deprived of oxygen. And letters had been sent to Tulare Regional and other hospitals in the Valley to let them know the system was ready for use.

Johnnathen, as it turns out, would be the hospital’s first cooling baby.

“To have a baby within three days … no one anticipated,” said Stacie Venkasen, a clinical nurse specialist at Children’s who helped train the staff. She was awakened Wednesday morning with a call to be at the hospital when Johnnathen arrived.

Children’s is the only hospital in the Valley with the system to induce whole-body hypothermia — or cooling — for birth-related brain injuries that can cause cerebral palsy, neurological problems and cognitive delays. The nearest cooling system is at the UC Davis Children’s Hospital in Sacramento. Davis began offering the therapy last year.

Not a new idea
The protective benefits of cold for the brain have been known for years. Young children who drowned in icy lakes and streams but were resuscitated, for example, have recovered with little or no brain damage.

Research published in the United States about four years ago showed the benefits for newborns deprived of oxygen, said Dr. Kajori Thusu, a Children’s neonatologist.

Babies whose bodies were cooled within six hours of birth and maintained at 92.3 degrees for 72 hours were less likely to die and had less risk of moderate and severe brain injury, according to the 2005 study in the New England Journal of Medicine.

The lack of oxygen to the brain causes a condition called hypoxic-ischemic encephalopathy. The brain reacts to the lack of oxygen by swelling, which cuts off blood supply and can lead to more damage. And as the body tries to protect the brain, other organs can be harmed, such as the kidneys and liver.

The damage happens over several hours before it becomes permanent — and that’s where quickly cooling the body can help. By lowering the body’s metabolism, the heart rate and blood pressure drop and the brain swelling is reduced.

But the problem has been determining the best way to cool the baby, Thusu said. One system uses a water-filled cap that fits over the baby’s head, she said. But a fluid-filled cooling blanket, like the one at Children’s, is more affordable, she said.

Children’s has been discussing the cooling blanket therapy for a couple of years, Thusu said. The hospital gets calls about babies in the Valley who could benefit from it, but has had to send them to hospitals in Southern California or the Bay Area for treatment, she said.

The Blanket Troll 3 cost Children’s about $30,000, Venkasen said. Children’s expects to use the blanket at most about 10 times a year, she said.

The criteria for using it are strict. Babies put on cooling blankets are full-term — at least 36 weeks gestation, Venkasen said. They must show signs of oxygen deprivation, such as poor muscle tone and seizures. And they must be less than 6 hours old.

Source: Fresnobee - Barbara Anderson - Nov. 22, 2010