Doctors at the UC Davis Medical Center have been using a technique for helping children born with brain damage. In a deviation from past standards, infants are being cared for with cooling. Instead of being placed in the typical blankets infants are placed in after birth, they are being cooled so as to prevent further brain damage from occurring.
The founder of the infant cooling program, called “Cool Babies,” is Ian Griffin, associate professor in the department of neonatology at UC Davis.
“We look for babies that are depressed at birth; babies that are not interactive and don’t move much at birth,” Griffin said.
Griffin said that the one of the most important effects of the cooling program is that it helps prevent the second wave of brain damage that occurs after birth.
“The cooling slows down the processes of the brain,” Griffin said. “It slows the metabolism, meaning we can calm down the second wave of damage that occurs.”
According to Griffin, the second wave of damage is propelled by the residual effects of the first wave of damage. The first wave of cells die due to lack of oxygen and build up of waste material; in the second wave, other cells die as a result of toxic compounds released from the cells that died in the first wave.
“With the cooling, it’s just like how icing an injury helps prevent swelling,” Griffin said.
In terms of how soon infants need to be cooled, Griffin said that infants need to be put in the cooling program within six hours of birth, but as soon as possible is best.
“The infants are put on a cooling mattress that actively cools their temperature,” Griffin said. “They stay cooled for 72 hours in temperatures ranging from 33 to 37 degrees Centigrade [91.4 to 98.6 degrees Fahrenheit], and are then re-warmed over a period of 12 hours.”
Griffin said that the infants typically spend 14 to 16 days in the hospital, where doctors keep following their neurological exams.
“The results are good. Maybe half of the babies will survive without significant handicap with cooling,” Griffin said. “Without the cooling, about one-third of the babies will survive without significant handicap.”
Griffin said that the program is important because it is the first time that doctors have been able to make a difference with affected infants.
“Before, all we did was support, look at the events and see how it turned out,” Griffin said.
According to Griffin, 58 babies have been cooled since the program’s start in June 2009. Griffin said that when they started, people were a little cautious about the program. However, within the last six to 12 months, recommendations for the cooling program have really taken off.
“It has started to be picked up nationally and internationally as well,” Griffin said. “Places like Italy and the United Kingdom have started to adopt this program.”
Jay Milstein, professor in the department of neonatology at UC Davis, believes the program is working wonderfully.
“It’s a boost to feel like, ‘Hey we may have something that makes a difference for high-risk infants,’” Milstein said.
Milstein said that the cooling program is showing encouraging results for infants with some minor brain damage.
“I’m excited about it, and it isn’t that difficult to perform,” Milstein said. “So many technologies used by doctors are so high tech that the availability may be limited; that isn’t the case here with the infant cooling program.”
Before this program, Milstein said that doctors would put infants in radiant warmers or incubators and keep babies at normal body temperatures.
“With this program, it’s a real deviation from normal resuscitation procedures,” Milstein said. “It’s a pleasant surprise when you see babies later and they are doing well.”
According to the World Health Organization, birth asphyxia — which it defines as the failure to establish breathing at birth — causes an estimated 900,000 infant deaths annually. Birth asphyxia is one of the main causes of lasting neurological damage in babies; Griffin hopes that the infant cooling program may increase the chances of many babies avoiding significant mental handicap.
ERIC C. LIPSKY can be reached at science@theaggie.org.
