Cooling Therapy Treatment for HIE (Hypoxic Ischemic Encephalopathy)

HIE, which is short for hypoxic ischemic encephalopathy, is a birth complication that happens when an infant suffers reduced blood flow and oxygen to the brain during delivery. HIE can result in permanent brain damage and is one of the leading causes of infant death. There are many reasons why an infant might be born with HIE, including the position of the umbilical cord, untreated medical conditions in the mother, and prolonged labor. Forty to sixty percent of infants with HIE either don’t survive past two years old or suffer a severe intellectual disability such as mental retardation, epilepsy, or cerebral palsy. In the past, treatment options were limited. 

Experimental new treatments, such as cooling therapy treatment, may reduce the mortality rate and the severity of brain damage caused by HIE when the infant’s brain doesn’t get enough oxygen. One option is to induce therapeutic hypothermia, which is the purpose of cooling therapy. Cooling the baby’s entire body and brain lowers the metabolic rate, which in turn limits or stops the death of brain cells. When brain cell death is prevented, it’s possible to avoid brain damage as the infant’s body is maintained at a significantly lower temperature. The brain cells are given a chance to recover from the birth injury. Research shows that the use of cooling therapy reduces the risk of permanent infant brain damage. 

The treatment is intended for infants carried to full term, and studies have shown no treatment benefit to infants born earlier than 36 weeks. Cooling therapy has to be administered within six hours following birth. The infant’s body temperature is cooled to 92.3 to 94.1 degrees Fahrenheit for 72 hours. Cooling therapy relies upon the active cooling of the baby’s entire body, but in some cases it may be necessary to use passive cooling in conjunction with active cooling. Passive cooling prepares the infant for active cooling upon arrival at a neonatal intensive care unit. It’s only used in situations when the birth happens at a location where cooling therapy can’t be started right away. 

For example, if the infant arrives at the medical facility when it’s dangerously close to the end of the crucial six-hour window to begin cooling therapy, medical professionals may start passive cooling to help the infant’s body temperature drop more quickly. The active cooling process varies by hospital. Some facilities may opt for a cooling blanket, where the infant is placed on a waterproof blanket with cold water circulating beneath it. A fan may be used along with other cooling methods.

Sometimes cooling devices are applied under the head in addition to the shoulders and chest. Some facilities may use cool packs, which are lowered down to 50 degrees Fahrenheit and wrapped in cotton before being applied to the infant’s body. Cool packs are cold but never frozen and never come into direct contact with the infant’s skin. The goal is to lower the infant’s core body temperature between 93.2 and 99.5 degrees Fahrenheit. Ideally, the body temperature should reach the desired range within the first hour and then cooling treatments are maintained for 72 hours. 

Once complete, the infant will be returned to a standard body temperature over a period of four to seven hours. Clinical trials have shown that cooling therapy treatment is a safe option for infants at risk of HIE. One study found that cooling treatment resulted in a significant reduction of mortality risk, brain damage, and other developmental problems by 12 months of age. In another study, a team of researchers monitored 208 infants born with HIE and conducted follow-ups after six or seven years. The study reported that children in the hypothermia group had a mortality rate of only 28 percent, which was a significant reduction compared with the control group’s mortality rate of 44 percent. 

The information available from clinical trials confirms that hypothermia treatment plays an active role in reducing mortality rate, neurodevelopmental delay and disability, cerebral palsy, cognitive delay, psychomotor delay, and severe visual deficit. In recent years, cooling therapy has become the standard neonatal care response to treating infants with HIE. Current standards make it mandatory for hospitals to offer it as a treatment option. However, cooling therapy is still an experimental medical treatment for HIE, and it’s not without some risks. Infants who are treated for HIE have already suffered a serious birth injury. 

It’s possible that induced hypothermia over an extended period of time can cause additional adverse events. Understanding that while there is often some form of risk with many medical treatments, clinical studies have shown that cooling therapy as a treatment for HIE is generally safe and poses few risks. This is especially true when the protocol is followed correctly and the infant is carefully monitored both during and after therapy. If you think your child’s experience with a cooling treatment for HIE was the result of medical negligence, please contact the team at Birth Injury Center to schedule a free consultation for legal assistance. 

Procuring legal advice is the first step in finding out whether you qualify for compensation due to medical malpractice. You will find abundant resources on our site where you can learn more about causes, treatments, family forums, parent support groups, and more. For your own peace of mind, please visit us at BirthInjuryCenter.org.