Katharine Meddles, MD, pediatric neurologist, Rocky Mountain Hospital for Children talks about a new method to help protect newborns from neurological damage following complicated deliveries.
Dr. Meddles: It would have been provided prior to cooling, so if they need antibiotics for any concern that there may be an infection, if they need any breathing support, we provide that, we monitor all their labs, make sure that they have enough fluid and nutrition. And additionally, every facility does it slightly differently. But typically, babies will undergo some form of EEG monitoring, which is where the pediatric neurologists come in. So, we’ll monitor their EEG, which is a test for – we put electrodes on the top of their head over the scalp and monitor their electrical activity, the brainwave activity of their brain. We’re looking in particular for seizures because babies who’ve had a difficult delivery are at high risk for having seizures in that time period. And that way we can treat the seizures and try to minimize any further injury that might come from uncontrolled seizures.
OK, so tell me about babies who have a traumatic birth and are at risk of seizures.
Dr. Meddles: So, we monitor them on EEG, which are electrodes that we put on the scalp. And these aren’t needles. They’re just stuck to the scalp with sort of a gentle glue. And we monitor babies for a period of 24 hours, which is the highest risk time frame for seizures if there are seizures. We make sure to treat them, to try to minimize any risk that those seizures might cause additional injury.
And how cool do you keep them?
Dr. Meddles: I have to check what it is in Fahrenheit. I think it’s about 34 degrees Celsius, which is three degrees Celsius below a normal average body temperature. So, the babies do sometimes shiver a little bit, and we give them morphine, just a low dose to help them if they are struggling with discomfort from cold. Some babies don’t like it and they’re a little crabby and actually that’s usually a really good sign if they’re sort of irritated by being cool and we give them medicine to help them feel more comfortable.
It just goes against everything. You’re just like warm them up, put a hat on, bundle them up, right? So, it feels like against every instinct.
Dr. Meddles: Yeah, definitely. And I think that’s hard for parents to see too. It’s unnatural to be sure, but it has been really convincingly shown to help babies in terms of their long-term outcome.
Why does it work?
Dr. Meddles: So when you have a hypoxic injury, meaning that the brain has been deprived of oxygen either because blood flow got stopped or because there was low oxygen in the blood going to the brain, there seems to be kind of an excitotoxic cascade. So, there’s a reaction to that injury that causes cells to respond actually in a counterproductive way. They become overactive and they start actually dying in response. Other cells that may not have taken as hard a hit may become overactive, and through this cascade and so cooling seems to interrupt that process. There are cells that are sort of on the fence. They’re not killed outright by the injury, but they may have this sort of counterproductive response. They can then induce cell death in themselves. And so, then you might lose more neurons, if you don’t interrupt that endpoint, that cytotoxic cascade.
Are there any risks to cooling the baby down?
Dr. Meddles: So, some babies can have problems with bleeding related to cooling. So, we monitor their coagulation markers to make sure that they can clot adequately and that they’re not at risk for bleeding. Typically, that can be managed and is not typically a reason for avoiding cooling. In very rare circumstances, babies, if they do have serious bleeding, do have to stop the cooling and then we will reward them in order to treat the bleeding. But that’s a highly unusual circumstance. And typically, we can manage it. The other reason that occasionally babies have to stop cooling is if they develop a condition called pulmonary hypertension. Basically, it’s a problem where the blood vessels in their lungs are constricting down and not allowing blood to flow well to the lungs. And so then obviously they have a lot of problems with breathing because they can’t get oxygen through their lungs, which is where their oxygenating their blood. Most of the time, again, we can treat them with a breathing tube and a ventilator and some other medications to help those blood vessels open up and the cooling can proceed.
So, this little baby today came and is going to spend three days, but there’ll be follow ups, come again and again.
Dr. Meddles: Yes, we monitor them closely actually while they’re in the NICU, also in part just because parents have a lot of questions, right? This is really unusual. It’s not what they expected. Nobody signed up for this or planned on it before delivery. And so, we answer questions about studies that we do in the NICU, so everybody gets a brain MRI to evaluate for the extent of injury. And we will talk to parents about the results and what that means for their child. We’ll talk to parents about what the EEG looks like what that means for their child, both in the short term and the long term. And then after they go home we typically see babies at about three months after. If they had an unusually complicated delivery and we’re managing seizure then we might see them back sooner. And then for children that we’re more worried about we may see them back every three months to help monitor development and make sure that therapies are instituted in a timely fashion.
Do they go back on the cooling bed then?
Dr. Meddles: No, they don’t. So, the cooling is only effective in that initial period which is why we have that.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Mari Abrams
Healthone’s Rocky Mountain Hospital for Children
(720) 754-4287
mari.abrams@healthonecares.com
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