NICU's new therapy for brain damaged babies

Babies at the Norfolk and Norwich University Hospital's neonatal intensive care unit have benefited from a new technique which cools babies starved of oxygen at or before birth to limit brain damage.

Major research has involved more than 300 babies in a trial carried out at 33 hospitals in the UK, including at NNUH, and in five other countries.

Researchers in the TOBY study found that full-term babies who suffered oxygen loss around the time of birth were 57% more likely to survive without brain damage if their bodies were cooled. The findings are published in the New England Journal of Medicine.

The babies' body temperature was brought down by about 4°C using a fluid-filled mat under their sheet. Doctors are not exactly sure why it helps, but think that slowing their metabolism reduces the after-shocks of the birth trauma, limiting further damage and giving the brain time to recover.

Dr Paul Clarke, consultant neonatologist at NNUH, said that the Norwich Neonatal Intensive Care Unit (NICU) was the only unit in the region to offer the treatment: “Our unit was one of those that participated in the TOBY study, and we contributed three babies to this landmark study.

Since the TOBY study ceased enrolment in November 2006, in view of mounting published evidence that cooling protects the brain in babies who have suffered asphyxia, we as a team decided we should continue to offer hypothermia treatment routinely to such babies.

We have cooled 13 babies since then who had been born with perinatal asphyxia and who were at very high risk of hypoxic-ischaemic brain injury. We have been able to offer this as part of their clinical care, using specialised cooling equipment (a cooling mattress), rectal thermometry, and assisted by cot-side cerebral function monitoring, which allows insight into the functional integrity of the neonatal brain.

This is the first time that doctors and nurses who care for asphyxiated newborn babies are able to offer a therapy with the potential to protect the brain and reduce the chances of permanent brain injury.”

The TOBY study builds on a 20-year body of research but gives, for the first time, compelling evidence that cooling is effective in reducing brain damage after perinatal asphyxia.

The study showed the proportion of babies that survived without signs of brain damage went from 28% to 44% with cooling treatments. Surviving babies who had received the cooling treatment were significantly less likely to have cerebral palsy at 18 months of age.

The trial involved 325 full-term babies who had been starved of oxygen during or before birth. Half of the newborn babies had their body temperature reduced to 33-34°C (91-93°F) for 72 hours followed by gradual re-warming in intensive care. Normal body temperature is around 37°C (98°F).

The study received nearly £1m of funding from the Medical Research Council and mostly involved hospitals in the UK, plus neonatal units in Ireland, Sweden Finland, Hungary and Israel.

The trial data will now be assessed by the National Institute for Health and Clinical Excellence (NICE) to see whether the technique should be rolled out to all neonatal units.

Thursday 8th of October 2009 11:00:11 AM