Cooling Lessens Brain Damage in Sick Newborn Babies
Jan 28, 2005
Cooling the brains of babies deprived of oxygen at birth may reduce the risk of brain damage, according to an international study published today in The Lancet in which the babies' body temperature was lowered by 3-4 degrees for 72 hours after birth using a water-filled cap.
The research was undertaken in hospitals in North America, New Zealand, and Europe. Babies were recruited if the infants received an inadequate supply of oxygen before birth and electrical activity from their brains showed a high risk of brain injury. The trial, which was supported by Olympic Medical of Seattle, USA, indicates that, for some babies, cooling can significantly reduce brain damage.
"This is the first treatment that has been proven to lessen the risk of brain injury in infants that have been deprived of oxygen before birth," comments Dr. Richard Polin, Professor of Pediatrics at Columbia University College ofPhysicians and Surgeons and Morgan Stanley Children's Hospital of NewYork-Presbyterian.
Dr. Donna Ferriero, Professor of Neurology and Pediatrics at the University of California San Francisco, points out, "These data suggest that therapy for ischemic injury in the newborn brain exists and may be realized in the near future."
Dr. Roberta Ballard, Professor of Pediatrics at the University of Pennsylvania School of Medicine and the Children's Hospital of Philadelphia, comments, "This is a very promising study of general hypothermia with selective head cooling for infants with evidence of recent, moderately severe lack of oxygen to the brain. However, there is still much to learn."
It was discovered several years ago that when the brain is deprived of oxygen at birth, some of the injury takes place hours, days, or weeks after the initial event and is initiated by a series of chemical events within the brain. The cooling study results from investigations begun a decade ago when researchers from Europe and New Zealand found that cooling prevented the chemical cascade from causing permanent brain damage. Those initial studies served as the basis for the cooling study in babies.
Two hundred and thirty-five babies with moderate to severe oxygen deprivation were recruited to the study. Of the 218 followed-up after 18 months, 55 percent of cooled infants had an unfavorable primary outcome (severe disability or death) compared with 66 percent of those who had received conventional care in neonatal units. If the infants most severely brain-damaged before entry to the trial were excluded, the combined rate of disability and death was reduced from 66 percent in the conventional care group to 48 percent in the cooled group.
Study investigators include the following: J. Kaiser (Arkansas Children's Hospital), M. Battin, D. Armstrong (University of Auckland – National Women's Hospital, NZ), J. Khan (Children's Memorial Hospital/Prentice Women's Hospital), T. Raju (University of Illinois at Chicago Medical Center), R. Polin, R. Sahni, U. Sanocka (Columbia University College of Physicians and Surgeons), A. Rosenberg, J. Paisley (Children's Hospital of Denver), R. Goldberg, M. Cotten (Duke University Medical Center), A. Peliowski, E. Phillipos (Royal Alexandra Hospital/ University of Alberta Hospital), D. Azzopardi, A.D. Edwards (Hammersmith Hospital, London, UK), F. Northington (Johns Hopkins University), J. Barks, S. Donn (University of Michigan Medical Center – Mott Children's Hospital), B. Couser (Children's Hospital and Clinics of Minneapolis), D. Durand (Children's Hospital and Research Center at Oakland), K. Sekar (Children's Hospital of Oklahoma), D. Davis, M. Blayney (Children's Hospital of Eastern Ontario/The Ottawa Hospital), S. Adeniyi-Jones (AI Dupont Children's Hospital at Thomas Jefferson University Medical Center), T. Yanowitz (Magee Women's Hospital/ Children's Hospital of Pittsburgh), R. Guillet, N. Laroia (Golisano Children's Hospital at Strong), N. Finer, F. Mannino (University of California San Diego Medical Center (Hillcrest)), J. Partridge (University of California San Francisco Children's Hospital), D. Davidson (Schneider Children's Hospital), A. Whitelaw (Southmead Hospital. Bristol, UK), M. Thoresen (St. Michael's Hospital, Bristol, UK), J.S. Wyatt, F. O'Brien (University College Hospital, London, UK), B. Walsh (Vanderbilt Children's Hospital,), J. Perciaccante, M. O'Shea (Wake Forest University Baptist Medical Center).
For more information, including interview requests, please contact:
Richard A. Polin, M.D., Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, NY, or any of the study site investigators.