Neonatal Encephalopathy and Body Cooling
Important information:
Neonatal encephalopathy is a condition in a baby that results in:
Neonatal encephalopathy can be from many causes. Some of these causes result in death, or survival with a disability. The degree of disability can vary, but it is sometimes very severe. Most times, the cause is not clear when babies are first born.
One of the causes of neonatal encephalopathy is hypoxic ischemic encephalopathy (HIE). This happens when there is a lack of oxygen delivery to many parts of the baby’s body (See pictures below. Blood with more oxygen is brighter red). This can lead to problems in many organs, including the brain.
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| Fetus/baby with normal oxygen delivery |
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Fetus/baby with less oxygen delivery |
If your team thinks that less oxygen delivery may be a cause, there is a treatment that has been helpful to babies.
What is the treatment for hypoxic ischemic encephalopathy?
We can provide support such as a mechanical ventilator to help your baby to breathe and increase their chance of survival. We can also try to protect the brain from further damage by carefully regulating the body temperature. For some babies this will involve cooling your baby to a lower-than-normal body temperature. For others, it will involve making sure that your body does not get too hot.
What is therapeutic hypothermia?
Therapeutic hypothermia is a way to carefully bring down your child’s body temperature. Research has shown that if this cooling treatment is started within 6 hours of birth, the chances of death or serious disabilities may be reduced for some babies. However, it is important to know that not all babies will respond to this treatment. For some babies, it is not advised to treat with lower body temperature and instead we make sure the body temperature is not too hot.
What would happen to my baby during temperature management?
Normal body temperature is 98.6 degrees Fahrenheit (37 degrees Celsius). Your baby would be placed on a water-filled cooling mattress. For those babies who will have hypothermia treatment, the mattress will reduce their body temperature to 92 degrees Fahrenheit (or 33.5 degrees Celsius). For those who will have normal temperature maintained, the mattress will be programmed to keep the body temperature in the normal range. The baby’s temperature is actively regulated for 3 days (72 hours). During this time, the cooling may cause a lower heart rate and changes in blood sugar levels. We will watch your baby closely for these changes.
We will also watch your baby’s electrical brain activity (EEG) carefully. This will show if your baby needs medication to treat or prevent seizures. It may also give information about if their brain is recovering.
After the three days of cooling, for those who are treated with hypothermia, we will slowly warm your baby to a normal body temperature and continue to watch them closely in the NICU.
What happens after temperature regulation is finished?
After a period of either cooling or maintenance of normal body temperature, most babies will get a brain MRI, which is a picture of the brain. This may help further understand the cause of neonatal encephalopathy. It may also help provide some information about your child’s future abilities.
After discharge from the hospital, your baby will need follow-up appointments with a developmental pediatrician, pediatric neurologist and/or developmental psychologist. These are experts in the growth and development of babies who can focus on their changing needs. They will even support you with school performance when that time comes.
How can I learn more about this treatment?
Your baby’s healthcare team will describe the cooling treatment to you in more detail and answer any questions you may have about the therapy, its potential risks, benefits, and unknowns.
Reviewed August 2024 by Lauren Heimall, MSN, PCNS-BC, John Flibotte, MD