During labor and delivery, low oxygen and blood flow to the baby’s brain can be detrimental, potentially leading to severe disability and developmental delays for the child later on in life. This includes hearing, sight, learning, and/or behavioral difficulties, as well as physical movement and coordination disabilities like cerebral palsy and other birth injuries. Fortunately, medical professionals have discovered a way to treat and counteract the consequences associated with oxygen deprivation and reduced blood flow: therapeutic hypothermia.
Therapeutic hypothermia, also known as total-body cooling or whole-body cooling therapy, has been shown to be successful in reversing the effects of HIE in oxygen-deprived newborns.
What is HIE?
Perinatal hypoxic-ischemic encephalopathy (HIE), also referred to as birth asphyxia, is a type of brain injury that occurs when a baby’s brain cells do not receive enough oxygen or blood flow during labor and delivery. If not addressed efficiently, oxygen deprivation can cause irreversible brain damage, permanently altering the child’s brain development and potentially leading to disabilities such as cerebral palsy, epilepsy, and more. In some more serious cases, failure to identify and address hypoxic-ischemic brain injuries can also lead to death.
Risk Factors for HIE
There are several risk factors that may increase the likelihood of an infant suffering from HIE. Of course, it’s important to note that just because these risk factors may be present does not always mean that HIE will occur. It is also important to note that sometimes HIE can occur without any identifiable risk factors at all. It all depends on the person and their unique situation.
That being said, some of the more commonly identifiable risk factors for HIE include:
- Fetal Distress – There are several different causes of fetal distress, but ultimately, anything that deprives the baby of oxygen and other nutrients may lead to fetal distress and, subsequently, HIE.
- Maternal Health Conditions – If the mother suffers from certain health conditions (i.e., heart disease, diabetes, preeclampsia, etc.), the baby might be at a higher risk of developing HIE. Other factors, such as the mother’s age, substance abuse during pregnancy, or the fact that they are a first-time mother can also present risks when it comes to fetal oxygenation.
- Uterine Rupture – A uterine rupture occurs when the mother’s uterus tears open and the unborn baby slips into the abdominal cavity, essentially suffocating the baby and increasing the risk of HIE or even death.
- Placental Abruption – Placental abruption occurs when the placenta separates from the uterus before birth, which can deprive the baby of necessary nutrients and oxygen. This, along with other placental abnormalities (placenta previa, placental insufficiency, etc.), can lead to the baby developing hypoxic-ischemic encephalopathy.
- Umbilical Cord Prolapse – When the umbilical cord slips through the mother’s cervix before the baby reaches the birth canal, this is known as umbilical cord prolapse. The cord becomes compressed between the baby’s body and the mother’s pelvic bones, resulting in a lack of oxygen supply to the infant.
- Long Labor – A long, difficult labor can compromise the baby’s safety and put significant stress on the body, increasing the risk of oxygen deprivation and therefore, hypoxic-ischemic brain injury.
How Does Whole-Body Cooling Therapy Work?
It is incredibly important that healthcare providers quickly identify and address the baby’s oxygen deprivation to minimize the potential repercussions. One of the most effective ways to do this is by inducing whole-body cooling therapy. Whole-body cooling treatment for newborns often takes place in the neonatal intensive care unit (NICU) and must occur within 6 hours of birth. This treatment works by intentionally inducing mild hypothermia in an infant for a specific period of time.
There are a couple of different ways to administer hypothermia therapy: via a cooling cap or a cooling blanket. As such, a cooling cap will either be placed on the baby’s head or the baby lies in a special blanket that circulates cold water. This generally lasts for 72 hours, or 3 days, following the baby’s birth. The goal is to bring the baby’s body temperature to about 91.4 to 92.3°F (33-33.5°C), which should reduce brain damage by lowering his or her metabolic rate and giving the cells a chance to recover. During the 72 hours that a baby undergoes cooling treatment, they should be closely monitored by medical professionals.
Once the treatment is completed, the newborn will be slowly warmed back up to normal body temperature (98.6°F or 37°C). This must not be done too quickly, as increasing body temp and restoring circulation too quickly can lead to even more damage.
Criteria for Cooling Therapy
The main criteria for administering cooling therapy to newborns include:
- Has been less than 6 hours since birth
- Baby reached a gestational age of at least 36 weeks before birth
- Baby shows signs of moderate to severe HIE
Is Cooling Therapy Dangerous for Babies?
Cooling treatment is generally safe when administered under appropriate medical supervision, but as with any medical treatment or intervention, there may always be certain risks to the baby’s health present. It is incredibly important that the treatment is administered by a qualified medical professional and that the baby is closely monitored during both the cooling and rewarming process.
Potential complications that can be associated with whole-body cooling in infants include:
- Increased heart rate
- Blood pressure fluctuations
- Blood clotting
- Infant seizures (often a result of the brain injury itself rather than cooling therapy)
- Electrolyte imbalances
- Infections
Regarding long-term outcomes, whole-body cooling has been shown to improve survival rates and reduce the risk of neurological problems in babies with HIE. In fact, studies have indicated that children who underwent hypothermia treatment have better cognitive and motor outcomes compared to those who did not.
Therapeutic Hypothermia Medical Malpractice
The effective management and response of healthcare providers during labor and delivery plays an absolutely critical role in minimizing the risk of birth injuries and death for both baby and mother. Medical professionals must consistently monitor the mother and baby for signs of HIE (and other complications, of course) and order the appropriate treatment in a timely manner.
Failure to order cooling therapy (whether at all or at the very least in a timely manner) when all signs point to it being the most appropriate solution can indicate negligence on behalf of the responsible physician. In other instances, unnecessary or improper protocol when performing cooling therapy can lead to further injury. Sometimes it is the negligence of a healthcare professional that led to your child developing HIE in the first place, and cooling therapy might not be entirely effective in reducing the damage that was caused.
In any of these situations, serious brain damage or even wrongful death may occur, and the victims and their families may have a valid medical malpractice lawsuit against the negligent provider(s). If this is the case for you, we highly encourage you to reach out to the Ohio and Northern Kentucky medical malpractice attorneys at TLF: The Medical Injury Law Firm.
Birth Injury? Call the Ohio and Kentucky Medical Malpractice Lawyers at TLF Today
Here at TLF, our team of experienced attorneys has decades of experience handling birth injury claims of all kinds, including those involving brain and whole-body cooling errors. We will conduct a thorough investigation into your claim, carefully examining all relevant details such as why the therapeutic hypothermia was necessary in the first place. If the hypothermia therapy was required as a result of a brain injury resulting from a medical error, if the therapy was not appropriately administered, or if a doctor failed to order the therapy altogether, we will diligently work to establish and prove this breach of medical duty.
To gain more insight into medical malpractice cases related to whole-body cooling for newborns, contact a Northern Kentucky or Cincinnati birth injury attorney from our law firm today at (800) 698-4054.