Therapeutic Hypothermia/Cooling for HIE

Hypoxic ischemic encephalopathy (HIE) is a condition that can develop in a baby when the brain fails to receive adequate amounts of blood or oxygen around the time of birth. To increase the chance of affected infants surviving without severe disabilities, a treatment called therapeutic hypothermia or cooling has been developed. Large clinical trials have shown that the early initiation of hypothermia results in a decreased incidence of death and severe neurodevelopmental disability in neonates with moderate to severe HIE. None of the published studies have shown any significant increase in adverse outcomes.

Cooling has quickly become the new standard of care for newborns with varying degrees of HIE. Each case must quickly and thoroughly be analyzed to determine if a particular baby qualifies for cooling. In order to be effective, cooling must be initiated within six hours of birth. If a baby qualifies for cooling, the baby is placed on a special cooling mattress that carefully brings the baby’s temperature down several degrees below normal body temperature. The infant is maintained at this temperature for three days and then slowly warmed back to normal body temperature.

During and after cooling, a variety of tests, evaluations and monitors are used to assess the infant’s condition. These include:

• Head ultrasound and brain MRI
• Continuous EEG monitoring with state-of-the-art seizure detection software
• Echocardiogram
• Evaluation by a pediatric neurologist

The Neonatal Neuroprotection Program (Cooling) team at St. Joseph’s Children’s Hospital uses a multidisciplinary approach for the treatment and evaluation of infants with HIE. The team is composed of a highly skilled neonatal/pediatric transport team, medical specialists in neonatology, neurology and specially trained nurses and respiratory therapists among others.