Therapeutic Hypothermia - Why Does My Child Need It?
When a newborn suffers a brain injury at birth it can be a very serious medical condition. Oxygen deprivation can occur during labor or delivery causing damage to the brain. Lack of oxygen causes a serious condition called hypoxic ischemic encephalopathy, HIE. HIE may result in developmental disabilities, cerebral palsy or even death.
Get A 100% Free CASE EvaluationThe severity of the disability depends on many factors most importantly how long the infant was oxygen deprived. Infants with HIE are examined to determine their level of injury.
Sarnat Scale
The Sarnat scale is a grading system for infants with HIE. It was developed in 1976 and is the most common grading system utilized for babies with hypoxic ischemic encephalopathy. It combines clinical and EEG findings to grade or score a child. There are three stages of HIE including mild, moderate and severe. When clinical findings are used alone, without EEG findings, it is called a modified Sarnat scale. It is helpful for parents to understand the level of HIE severity of their child.
Stage I - Mild
- Hyper-alert
- Wide open eyes
- Irritable
- No seizures
- Lack of sleep
- Typically lasts for less than 24 hours
Stage II – Moderate
- Lethargic
- Reduced tone to arms, legs, or body
- Reduced reflexes (pupil, gag, suck)
- May have clinical seizures
Stage III – Severe
- Comatose
- Weak respiration
- No response to stimuli
- Floppy or flaccid tone of arms and legs
- Absent or diminished reflexes (pupil, gag, suck)
- Diminished reflexes of tendons
- Suppressed or flat EEG
Treatment for HIE
There are some traditional treatments for hypoxic ischemic encephalopathy including ventilation for babies who require breathing assistance, medications to control blood pressure, and medication to prevent or manage seizures. Therapeutic hypothermia is a somewhat new treatment that provides cooling to assist in controlling damage caused by oxygen deprivation. The goal of these treatments is to support the infant’s organs, control symptoms, and minimize brain cell damage.
Cooling Therapy for HIE
Cooling therapy is also known as therapeutic hypothermia. The body’s normal temperature is 98.6 degrees Fahrenheit. However, it has been found that when the body’s temperature is cooled it slows the processes and can provide a longer window of time for healing to take place. Therapeutic hypothermia cools the body down to 92 degrees Fahrenheit; the optimal temperature found to promote healing and reduce further brain cell damage from occurring. The infant must start treatment no later than 6 hours after birth and continue treatment for a period of 72 hours.
Therapeutic hypothermia allows for the best possible outcome for an infant who suffers from HIE. While the therapy may not provide improvement for every infant, the potential for an improved outcome is a reason to take part in cooling therapy. Infants who are cooled at birth may have a better long-term prognosis than children who were similarly injured but did not receive such treatment. The prognosis for babies diagnosed with HIE varies greatly from child to child. It is advisable to discuss your child’s medical issues and prognosis with a physician to learn as much as possible about possible treatments and ongoing care choices.