Brain Cooling in Neonates: The Medical-Legal Implication (Part 1 of 3)

Cerebral palsy can be the outcome of either negligent or non-negligent obstetrical care. However, regardless of the cause, a child diagnosed with cerebral palsy faces a lifetime of required medical and attendant care. Such care places an emotional and financial burden on both the family and society. Where there is sufficient evidence of negligent obstetrical care, such "brain-injury baby" cases can result in a financial recovery that at least provides some assistance to a family faced with the lifetime care of such a child.

Until recently such financial assistance through the legal system was the only hope that could be offered to the family of a child with negligently-caused cerebral palsy. However, within the last 10 years a new treatment has been developed which may change the long-term outcome for such a "brain-injured baby." This treatment is called brain cooling, and it is based on scientific research showing that injury to a neonatal brain from hypoxia and ischemia during the birth process does not occur immediately, but occurs over several hours.

The initial lack of oxygen (hypoxia) and/or lack of blood supply (ischemia) to the brain kicks off a series of other events, as the body tries to repair itself. This natural approach may be effective when the Hypoxic-Ischemic Encephalopathy (HIE) is mild, but in moderate or severe cases the body's desperate attempts to heal can cause more brain damage. 

Brain cooling interrupts the evolution of progressive damages to the baby's brain that are thought to be caused by a complex biochemical cascade. Brain cooling is performed over a 72-hour period, but it must be started within six hours of delivery. The body temperature of the infant is reduced 3 to 4 degrees Celsius from a normal of 37 degrees to 33.0 to 34.5 degrees.

The Food and Drug Administration (FDA) has approved the Olympic Cool-Cap System for selective head cooling treatment of neonatal HIE. The first studies on brain cooling were focused on the risks of brain cooling, and they showed that brain cooling was a safe procedure, but more recent studies have shown that induction of moderate hypothermia for 72 hours in infants who had perinatal asphyxia did not significantly reduce the combined rate of death or severe disability, but "resulted in improved neurologic outcomes in survivors."

The most recent literature reviewed the status of multiple studies which have looked at brain cooling and neurologic outcomes, and concluded that "in infants with hypoxic-ischemic encephalopathy, moderate hypothermia is associated with a consistent reduction in death and neurological impairment at 18 months."

**This is an excerpt from an article written by Dr. Bruce Fagel, which originally appeared in the January/February 2011 issue of the Consumer Attorneys of California's Forum Magazine.