Cooling therapy is a medical intervention used to treat hypoxic ischemic encephalopathy (HIE) and prevent or reduce permanent brain damage. When done properly, head cooling is an effective way of protecting a baby's health. It's also an indicator that something went wrong - and that something may have been preventable.
How head cooling and whole-body cooling work
Cooling therapy is nothing new. People throughout the world have been using induced hypothermia to treat newborn infants for centuries.
Head cooling therapy involves putting a cooling cap or similar device to cool the baby's head to 92-94 degrees Fahrenheit, which is somewhat below the normal body temperature of 98.6 degrees. In more severe instances, whole-body cooling is used, with a blanket or similar device cooling the entire body. Cooling the brain is believed to slow down the baby's metabolism and reduce disruptions in the blood-brain barrier. This can slow natural processes that can cause permanent brain injury if they are allowed to proceed too quickly.
Depending on the severity of the injury, cooling therapy is generally performed for two to three days. After three days, the child is then slowly warmed up, so as not to cause other health problems, including reperfusion injury.
Cooling therapy should begin as soon as possible when the baby is born and no later than six hours after birth. In other words, if the hospital has a NICU or other resources for cooling therapy, the baby needs to be brought there right away to begin cooling therapy. If those resources are not available at the location where the baby is born, ice packs can be used temporarily while transferring the baby to another location.
Numerous studies have found that whole-body cooling can be effective in many situations. One study conducted by the Health Research Council of New Zealand concluded that "there is now overwhelming clinical and experimental evidence that mild to moderate post-asphyxial cerebral cooling is associated with long-term improved survival without disability."
The role of negligence in head cooling and whole-body cooling treatment
Cooling therapy is an intervention that is needed if the baby starts to show signs of oxygen deprivation or brain damage; for example, if the baby's heart rate is found to be under 110 beats per minute (bpm) or the score on the Apgar test, and particularly the respiration portion of that test, is low. While cooling is the correct medical intervention in certain circumstances, it's always important to ask why that intervention was needed in the first place. HIE often happens due to preventable causes, and in such circumstances, the risk of brain damage could have been averted entirely if the doctors had taken prompt, appropriate action during labor and delivery.
In addition, head cooling or whole-body cooling can have risks for the baby if it is performed incorrectly - for example, if the baby is cooled down or warmed up too quickly, or if the body temperature drops below 92 degrees. And the sooner cooling therapy is done, the better. If signs of brain damage were apparent at the five-minute mark but doctors waited another hour or more before starting cooling therapy, that could be indicative of negligence.
In short, finding out what happened takes on greater importance if your baby underwent cooling therapy after birth. An attorney licensed in your jurisdiction can help you understand what happened, as well as your legal options, in a free consultation.