Cooling wrap offers treatment for at-risk newborn infants


What every expectant mom and dad want most is a healthy, normal baby. But when little ones have trouble transitioning from the womb to the outside world, their lives may be at serious risk. Now a new treatment is giving these babies a chance to fight for their lives.

He's only 7 weeks old, but Tyler Evans is one tough little man.

"One of the doctors said he's gone through more during his first week on this Earth than most of us would ever go through in our lifetime," said Tyler's father, Ken.

Tiffany's pregnancy was normal, but from the minute Tyler was born, he was in trouble.

"Once he came out, immediately I saw the cord around his neck, and it was extremely tight," said Ken.

Tyler was rushed to St. Louis Children's Hospital where a new procedure called therapeutic hypothermia has become a game-changer for these at-risk newborns.

"This is a big deal. We've not had anything specific for the brain for decades," said Dr. Amit Mathur, neonatal ICU medical director, St. Louis Children's Hospital.

With continuous neurophysiologic monitoring, newborns spend 72 hours wrapped in a special blanket that lowers their body temperature 3 to 4 degrees.

"And what that results in is a decrease in the metabolic demand for the brain, which has been shown to be protective when done over three days," said Mathur.

The newborn cooling treatment can reduce the chances of severe brain injury or death by 25 percent.

"The first MRI was fine, and that's where they find the major head trauma or any brain damage, and he was fine," said Tiffany. "Everything was normal."

"He's doing awesome," said Ken.

Now Tyler is on his way to a healthy future.

"He's meeting all his milestones on time, and we still consider him a great little miracle," said Tiffany.

Several international studies found the sooner the cooling treatment begins after birth, the greater the potential benefit for at-risk babies.

BACKGROUND: Therapeutic hypothermia involves lowering a newborn's body temperature from a standard 37 degrees to 33.5 degrees. Cooling wraps that circulate cool water are placed around a newborn's arms and trunk area. After three days, babies are slowly warmed over a 24-hour-period. In addition to cooling the baby, continuous brain monitoring and neurological consultation with early rehabilitation services occur with all high-risk infants in the neonatal intensive care unit (NICU) to assist in optimal care and outcome.

NEW FINDINGS: A four-year randomized, controlled trial of 400 newborns at five centers around the world has yielded parallel findings of benefit from therapeutic hypothermia that rendered this treatment as a standard of care in many Level 3 Newborn ICUs. Doctors at St. Louis Children's Hospital have already altered the outcomes of many poor-performing newborns. They've found that therapeutic hypothermia can reduce the chance of severe brain injury by 25 percent in term-born babies with poor transition or low Apgar scores after birth. It is very important that these babies are given the cooling treatment as soon as possible because it appears the treatment may not work as well after the first few hours of life.

THE PROCESS: At St. Louis Children's Hospital, when concern of a brain injury is present, early referral and evaluation are suggested. Doctors advise the referring team on how to manage the temperature of the baby until the arrival of the transport team, who then initiates the cooling process in route. As soon as the baby is admitted to the neonatal unit, the team transfers him or her to a different type of cooling device. It's been shown that the earlier neuro-protective therapy begins, the more benefit a baby will experience.


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