Newark, NJ—A full-term newborn transferred to Children’s Hospital of New Jersey (CHNJ) at Newark Beth Israel Medical Center became the first baby in New Jersey to receive treatment using therapeutic hypothermia, the deliberate lowering of the body temperature to prevent brain injury. The baby boy’s body temperature was lowered with a cooling blanket from 37 degrees C to 33.5 degrees C and maintained there for a period of 72-hours before being gradually re-warmed over 18 hours. As a result, he has made a full recovery.
On November 4, 2008 the baby, who had experienced a lack of oxygen to the brain, was transported to CHNJ from a Hudson County hospital. Initial resuscitation was immediately started to prevent perinatal asphyxia, a condition resulting from deprivation of oxygen to a newborn infant long enough to cause harm. Perinatal asphyxia occurs in 2 to 10 per 1000 newborns.
Morris Cohen, M.D., Director of Neonatal Medicine at CHNJ, and the neonatal team used therapeutic hypothermia techniques to cool the infant’s brain and stop the dangerous inflammatory reaction from continuing.
“In the same way that water is used to cool a burn and limit the damage, cooling the brain stops the inflammatory reaction from continuing and prevents further injury,” reports Dr. Cohen.
Several recent studies, including one in The Lancet, 2005, have shown the efficacy of therapeutic hypothermia techniques for full term babies over 35 weeks of age, if the procedure is done within six hours of the onset of the condition. The studies also show that whole body cooling, rather than just lowering the head temperature, may be the preferred approach to fully cool the central brain, says Dr. Cohen.
“The data seems to confirm that treatment is most effective if done immediately, so it is important for parents and referring physicians to be aware of this window of opportunity,” says Dr. Cohen.
A Successful Intervention
The baby was delivered that day at 11:00am and later that day, while breastfeeding, the infant went into unexplained distress and had difficulty breathing and suffered a cardio-respiratory arrest. After a successful resuscitation and transfer to CHNJ, he was cooled for 72-hour period with a specially designed blanket called “the blanketrol III” made by Cicinati Sub-zero.
The baby's temperature was measured throughout to ensure that the right amount of cooling and all vital functions were carefully monitored. After 72-hours, the baby's temperature was gradually returned to normal. A subsequent EEG and MRI have yielded normal readings.
“The prognosis for this newborn is very good, “adds Dr Cohen. “He tolerated the treatment very smoothly and he appears to be completely normal in function.”
Clinical studies indicate induced managed hypothermia can reduce long-term neurological damage after sudden cardiac arrest, in instances of severe cardiac surgery, after stroke, following a spine or head trauma, and in cases of neonatal asphyxia. Of those who survive sudden cardiac arrest, for example, therapeutic hypothermia can significantly improve -- by 20% or more -- neurological outcomes.
The NICU at CHNJ
The Division of Neonatology is a Level III Regional Perinatal Center, which provides highly specialized treatment to nearly 1000 premature and critically ill newborns each year and receives referrals from more than 15 hospitals in New Jersey and surrounding states. While the number of low birth weight babies ranks among the highest percentiles nationally, our survival rates are among the top quartile.
The neonatal team consists of 16 board-certified neonatologists, specially trained nurse practitioners and neonatal nurses, therapists, social workers and technologists who work together under the principles of family-centered care. Neonatologists are available 24 hours a day, seven days a week to provide care for these fragile newborns. The NICU provides specialized care for newborns and offers New Jersey’s only Extracorporeal Membrane Oxygenation (ECMO) therapy for infants in severe respiratory distress.
For referral to a CHNJ pediatrician or specialist, please call 1-888-SBHS-123.
DATE: November 18 , 2008
CONTACT: Beth Salamon, Public Relations (973) 322-4926
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