Whole Body Cooling

Within the last number of years there have been significant advances in the knowledge and use of head and whole body cooling to reduce the extent of brain injury associated with a hypoxic ischemic event (an inadequate supply of oxygen to the brain). Those healthcare professionals that practice obstetrics, and physicians who care for newborn children, have an obligation to remain current with these medical developments, to be aware of the inclusion criteria and to have appropriate systems in place to ensure the effective referral and transport of newborn babies who might benefit from cooling to the appropriate neonatal intensive care unit.

A hypoxic ischemic event during labour can result in a brain injury through two mechanisms. The first is often referred to as the primary insult and refers to the death of the brain cells associated with the hypoxic ischemic event itself. The secondary insult, which can also result in the death of brain cells, occurs with the swelling of the brain in response to the initial insult. This swelling starts approximately 6 hours after the initial insult and it is these 6 hours that give healthcare professionals time to cool the newborn which in turn reduces the swelling and the extent of the secondary insult.

It is therefore essential that the healthcare providers know the inclusion criteria and carefully analyze the clinical situation to determine whether the newborn falls within the criteria. The current criteria requires that the baby be more than 35 weeks gestation, weigh more than 1,800 grams, have evidence of a hypoxic ischemic event during labour based upon an analysis of the
blood from the umbilical cord and that the cooling process can begin before 6 hours of age.

There have been some exciting new developments in the area of head and body cooling with some very good results. Healthcare providers practicing obstetrics and those in charge of newborns must ensure that they remain current with the latest developments in this area and have appropriate policies in place to ensure that newborns that meet the inclusion criteria receive the care they deserve.