Therapeutic hypothermia
The purpose of therapeutic hypothermia is to limit brain injury that may occur as a result of oxygen deprivation before or during birth.
About the treatment
Therapeutic hypothermia has been the standard treatment for newborns with birth asphyxia (lack of oxygen) in Norway since 2010. The decision to start treatment is based on specific criteria, and the treatment follows a national protocol. Treatment should be started within 6 hours after birth.
How is the treatment carried out?
As soon as possible after birth, the baby is cooled down to a body temperature of 33.5 °C. This is done by placing the baby on a mattress containing water. The mattress is connected to a machine that regulates the temperature of the water to maintain the baby’s desired body temperature.
To achieve the best possible effect of the treatment, it is important that the baby is calm and receives adequate pain relief. The baby’s need for pain medication is assessed continuously. The medication used is morphine-based and can affect breathing. Therefore, the baby needs breathing support and is placed on a ventilator.
The baby is closely monitored, and we follow all organ functions. This includes repeated blood tests and continuous monitoring of heart rate, blood pressure, oxygen levels in the blood, and brain activity. The baby receives only small amounts of milk while cooled. All fluids and nutrition are given intravenously through a cannula and a catheter in the umbilical vein. The baby has a urinary catheter so that we can monitor urine production.
Babies who have experienced oxygen deprivation to the brain may develop seizures. If this happens, the seizures are treated with medication.
After 72 hours, the baby is slowly warmed up to normal body temperature. The baby remains on the cooling mattress for another 12 hours after rewarming to help stabilise the temperature. In total, the baby usually stays on the cooling mattress for around 4 days. After rewarming, an MRI scan of the brain is performed to look for signs of brain injury.
The first few days of treatment are intensive. When the baby is taken off the cooling mattress and the MRI has been completed, the situation usually improves quite quickly. Many wires and tubes can be removed, the baby wakes up, and the parents can hold their baby.