Infants born with oxygen loss who are given an innovative therapy thatlowers their entire body temperature by four degrees within the firstsix hours of life, have a better chance of survival and lower incidenceof brain injury, according to a report in the October 13 issue of theNew England Journal of Medicine.
"We speculate that this therapy lowers the brain temperature as well asbody temperature and slows down the injury process caused by birthasphyxia, which results in loss of oxygen to the brain," said Yaleresearcher Richard A. Ehrenkranz, M.D., professor of pediatricneonatology and obstetrics and gynecology at Yale School of Medicineand Yale-New Haven Hospital. "Less injury means a better outcome andfewer cases of cerebral palsy and other complications."
Ehrenkranz co-authored the study with colleagues at 14 otherinstitutions in the National Institute of Child Health and HumanDevelopment Neonatal Research Network.
Hypoxic ischemic encephalopathy (HIE) occurs when an infant's brainfails to receive sufficient oxygen or blood before birth. The conditionmay occur hours before birth or during labor and delivery. It can becaused by complications such as compression or tearing of the placentaor the umbilical cord and rupture of the uterus. Many infants whosurvive HIE experience brain disability.
The team, led by Seetha Shankaran, M.D., at Wayne State Universitystudied the effect of hypothermia or reduced body temperature, infull-term infants with asphyxia and related complications at birth.Researchers randomly assigned 208 infants to either a control group ora whole-body cooling group where their body temperature was kept at92.3 degrees for 72 hours, then slowly re-warmed. Body temperatureswere lowered by placing babies on a blanket initially filled withcirculating 41-degree water. Both groups received standard newbornintensive care including monitoring of vital signs.
When the infants were examined to assess their outcome at 18 to 22months of age, 44 percent of those in the group treated withhypothermia developed a moderate to severe disability or had died, ascompared to 62 percent in the control group.
The Neonatal Research Network will also follow both groups of childrenuntil they reach age six or seven, to compare the incidence of healthproblems or learning difficulties.
Citation: New England Journal of Medicine 353; 15 (October 13, 2005)
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