Touching Lives - October 2010
Cooling therapy helps prevent brain damage in newborn babies
One of the three leading causes of death in newborn babies is a condition called hypoxic-ischaemic encephalopathy (HIE), or perinatal asphyxia. This occurs when a baby suffers a shortage of oxygen or blood supply to the brain around the time of birth, leading to brain injury. In severe cases, 25–50 per cent of babies may die, and those who survive are at risk of disabilities like cerebral palsy, blindness and epilepsy.
Now, a new cooling therapy is set to help these babies. The treatment takes advantage of a therapeutic window that occurs after a newborn baby suffers oxygen shortage. By cooling the body (a technique called therapeutic hypothermia) to reduce brain temperature, doctors can alter the chemical processes that lead to brain damage. As soon as possible after birth, and with strict controls in place, the baby is cooled with a purposemade cap or with a special blanket or mattress. After about three days, the baby is gradually warmed again.
This breakthrough came from a 20-year programme of research, to which Action Medical Research contributed. For decades, the charity has supported studies across the country tackling infant brain damage, including the work of many researchers who have contributed to therapeutic hypothermia.
One of the charity’s past trustees, Professor Osmund Reynolds, led a research programme in this area at University College London (UCL) involving researchers such as Professor John Wyatt, Professor Marianne Thoresen and Professor David Edwards, who have been actively involved in progressing cooling therapy to where it is today. Professor Wyatt says: “Arguably, hypothermia treatment is the biggest advance in neonatal care in the last decade.”
Professor Wyatt and colleagues at UCL conducted some of the most vital research supported by the charity and a generous donation from The Garfield Weston Foundation. They carried out fundamental laboratory work, looking at factors such as the timing and intensity of cooling, helping establish the importance of starting cooling soon after delivery and developing magnetic resonance techniques for measuring brain temperature. They also studied babies using sophisticated scanning techniques and measuring electrical changes in the brain to help with early prediction of a longer-term outcome and quick identification of babies who would potentially benefit from cooling.
Their work was of central importance in the development of clinical trials of cooling. In conjunction with this work, the team participated in the international CoolCap study, the first published major trial to show a benefit. Other key trials have since been conducted, such as the TOBY trial, funded by the UK Medical Research Council. Over the last decade, these trials have built up powerful evidence supporting the safety and effectiveness of cooling. The National Institute for Health and Clinical Excellence (NICE) has published guidance supporting its use in carefully selected newborn babies. Professor Edwards says: “A 20-year programme of careful laboratory and clinical research has proved that cooling reduces neurological damage in babies at risk of brain damage due to a shortage of oxygen.”
The next step is finding additional ways to protect babies. Action Medical Research is supporting studies looking at brain development in unborn babies, brain cell death following oxygen shortage, brain haemorrhage in newborns, development of a brain atlas for premature babies and computer-aided diagnosis of brain injury.
The charity is also funding a study at Imperial College London investigating the theory that giving women inhaled xenon and sevoflurane during childbirth may both relieve labour pains and protect their babies from brain damage. Most recently, a grant has been awarded to Dr Nikki Robertson and colleagues at UCL and Imperial College London to study the combination of cooling therapy and a sedative drug called dexmedetomidine.
Cooling therapy is being increasingly offered to newborn babies, both in the UK and other countries. This groundbreaking treatment has therefore already begun to benefit vulnerable infants. Action Medical Research celebrates its contribution to this pioneering therapy, which will have a lifelong impact on so many children.