So, do we keep the baby warm or do we uncover it and let it cool? MM
Cooling blankets may reduce newborn brain damage BY RONI RABIN STAFF WRITER October 12, 2005, 8:22 PM EDT Lowering a newborn's body temperature after birth reduces risk of brain damage and death for babies who are deprived of oxygen before or during delivery, a new study has found. Within hours of being born, newborns in the study were placed on cooling blankets that lowered their body temperature to about 92 degrees. The blankets, which had water circulating through them, were set at 41 degrees. After three days, the babies were gradually warmed to a normal body temperature, which usually ranges from 99.7 degrees to 99.3 degrees. The study of 208 infants at 15 medical centers was reported by researchers in the Neonatal Research Network of the National Institute of Child Health and Human Development, and appears today in the New England Journal of Medicine. "This is a very exciting, landmark study," said lead author Dr. Seetha Shankaran, head of the division of neonatal-perinatal medicine at Wayne State University School of Medicine in Detroit. But the sponsors also urged caution, saying further research is necessary and warning that most hospitals should not attempt to the technique without training of personnel. The babies must be closely monitored and strict protocols must be followed because temperature fluctuations could be harmful, the study authors said. One in every 1,000 to 2,000 babies born suffers from hypoxic ischemic encephalopathy, which occurs when the brain doesn't get enough oxygen or blood in the hours before birth or during labor and delivery. These babies are at markedly increased risk of disability, including blindness and cerebral palsy, as well as death. Babies who received the cooling treatment fared better than babies provided with standard treatment. Of the 208 babies in the study, 102 infants were randomly assigned to undergo the experimental cooling while 106 received standard care. When the babies were examined at 18 to 22 months, 62 percent of the babies who received the standard treatment had died or developed a mild or severe disability, compared to 44 percent of those who had the cooling treatment. When all three outcomes -- death, moderate disability and severe disability -- were pooled, findings were statistically significant. Among those who were cooled, 24 died, compared with 38 deaths in the control group. Fifteen infants who had the experimental treatment developed cerebral palsy and five went blind, compared with 19 and nine, respectively, of thosee who had standard care. Infants who received the cooling treatment also scored better on mental and physical development measures, the authors said. The children will be followed until they are 6 or 7 years old. Several other studies investigating the benefits of cooling treatment are under way. Researchers at Schneider Children's Hospital in New Hyde Park have participated in a study that used a cooling "cap" to mitigate brain damage in newborns similarly afflicted by oxygen deprivation, and other studies are under way in Australia and England. "They key thing is that the cooling, whether by blanket or by cap, helps some babies," said Dr. Andrew Steele, a neonatologist at Schneider Children's Hospital involved in the cooling cap study. Shankaran explained that when the brain is deprived of oxygen and blood, a cascade of abnormal events occurs, including formation of toxins and amino acids that damage brain cells. Cooling appears to work by reducing the energy of the brain itself, she said, thereby decreasing the abnormal toxins and actually reducing the swelling of brain cells. "It is a very promising, evolving therapy, but there's a lot more work to be done, alot of questions still to be answered," said Dr. Ann Stark, chair of the American Academy of Pediatrics Committee on the Fetus and Newborn Health. Copyright 2005 Newsday Inc. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
