Fighting to Reduce Brain Injuries at Birth

f all the things that can go wrong as a woman is delivering a baby, detachment of the placenta from the fetus may be the most alarming. Suddenly, the blood and oxygen supply is cut off, triggering a slow but tenacious destruction across the baby’s brain. The result can be mental retardation, cerebral palsy, seizures or even death.

“These are babies who you want to be able to offer something to,” says neonatologist Susan Aucott, M.D. “But despite years and years of searching, all we’ve been able to do is support them on a ventilator.”

Now, for the first time, it appears that a new brain-cooling therapy under trial here has the potential to reduce brain injury in these newborns. The key is a plastic, weblike hat that fits over the baby’s head that makes it possible for neonatologists to induce hypothermia (extreme cooling) in the brain without cooling off the baby’s body (which could result in other dangerous problems). As the infant rests in a radiant warmer that keeps its body temperature just slightly below normal, cool water is pumped into the hat, dramatically lowering the temperature of the brain. The technique appears to stop the cascade of events that lead to neuronal death.

Preliminary studies and animal models show that the therapy is safe. What still isn’t clear is how long the effects of the brain-cooling last, or whether it slows rather than stops cell death. “Nonetheless,” says pediatric neurologist Rebecca Ichord, “you look at images of a region of the brain where you normally see 70 to 90 percent of the cells dying, and at three days of brain-cooling you see zero percent of cell death. I’ve been studying this problem for 20 years, and this is the first time I actually have a realistic hope that we can have a positive impact on some of the babies with this condition.”

—- Gary Logan