Oxygen deprivation in newborns and the promise of hypothermia treatment

Oxygen deprivation in newborn babies, also known as perinatal asphyxia or hypoxic-ischemic encephalopathy, can lead to cerebral palsy, epilepsy, and problems in brain development later in life. This condition affects nearly 2 in 1000 births worldwide and can affect anyone regardless of the wealth, education or access to health care. Traditionally, once the damage was done there was no treatment beyond teaching the family to cope with the disabilities that come with the brain damage and using physical therapy to treat the motor impairments. However, recently hypothermia has shown promise as a treatment for preventing the damage from the lack of oxygen. Wait, hypothermia? Don’t people die from that? Well yes, but it can also be an effective treatment option.

Hypothermia is a condition where a persons body temperature falls below 35°C (or 95°F) and may result in a person becoming pale and sluggish, unconsciousness, and eventually may lead to death if your body temperature drops too low (below 28°C). Typically you hear of people getting hypothermia when they are trapped by an avalanche or lost in the wilderness during the colder seasons. If hypothermia is dangerous, then how could it be possibly used as a treatment for anything? Well, hypothermia also results in a decrease in your body’s metabolism and this can be beneficial in treating serious conditions including: cardiac arrest (heart attack), head injuries, and strokes. The dampening of your metabolism from therapeutic hypothermia prevents your body from damaging your tissues. It is this damage, to your brain in the case of oxygen depravation, which causes the symptoms and long lasting problems.

In the study, published in the New England Journal of Medicine, 325 newborns with oxygen deprivation where randomly assigned into two groups, one which received the standard care (so called gold standard) and one who got the standard care plus therapeutic hypothermia. The babies who got the therapeutic hypothermia had their body temperature cooled to about 33°C for 72 hours. The kids were then followed up when they were 6 or 7 to evaluate their brain function. The researchers saw that kids who had the hypothermic treatment had a significantly greater chance of surviving with an IQ over 85. Having said that, there was still an equal number of children who died in both groups so the hypothermic treatment didn’t prevent casualties but it did help the survivors maintain adequate brain function. Other notable outcomes were that children with the hypothermic treatment had a lower risk of developing cerebral palsy, had better motor function (control of their limbs) and had fewer disabilities. The results of the clinical trial are promising in relieving some of the disabilities that may develop from this disorder. Hypothermic treatment has been investigated recently for stabbing and gunshot victims, giving doctors time to repair their wounds. It appears that the future of medicine in the trauma centre may involve giving patients a cold shoulder, or brain….

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