A Baby’s “Cool” Battle with Brain Injury

Hadley Septembre’s first challenge coming into the world was umbilical cord prolapse, a childbirth complication in which the umbilical cord drops through the open cervix into the vaginal canal ahead of the baby. In such cases, the baby can press against the cord and block vital oxygen supply to the brain, a life-threatening condition called hypoxic ischemic encephalopathy, or HIE. Obstetricians at Anne Arundel Medical Center (AAMC) delivered Hadley via an emergency cesarean section and hoped for the best but—as Hadley was lifted motionless from her mother’s womb—feared the worst.

“When the doctor looked at her, he did not think she was alive,” says Wendy Septembre, Hadley’s mom.

But there were signs of life in the limp newborn; she had a strong pulse but was not breathing. Staff members were able to revive her after some time and get her to start breathing on her own for the first time ever. Doctors at AAMC knew Hadley needed high-level neonatal intensive care quickly and transferred her to the Johns Hopkins Neurosciences Intensive Care Nursery, a unit designed to treat newborns at high risk of brain injury. There neonatologists moved quickly to liberate Hadley’s brain from the ravages of HIE.

“We have a very short time in which we can help rescue the brain and stop the neuronal cell death that begins immediately and escalates rapidly,” explains neonatologist Frances Northington. “We have just minutes to hours to intervene.”

Northington and her team recommended therapeutic hypothermia, or brain cooling therapy, for Hadley. The once-novel treatment, under study at Johns Hopkins since 2000, is now becoming the standard of care for HIE.

How does it work? To cool the baby’s head without cooling off the body, which could result in other problems, Hadley would rest in a radiant warmer to keep her body temperature just slightly below normal as cool water was pumped into a cooling blanket.

“We cool the baby to a temperature of 33.5 Celcius, or 92.3 degrees Fahrenheit, which is fairly cold,” says Northington. “It interrupts the injurious metabolic processes causing the neurons to die.”

The Septembres were stunned by Hadley’s condition but confident in the treatment. “They explained everything to me, and they were very positive and upbeat about the protocol,” says Sam Septembre.

After three days, Hadley’s body temperature was gradually raised to normal levels. During treatment, Hadley did experience a collapsed lung and pulmonary hypertension, but she recovered with no life-limiting, long-term effects.

“I would say to any parent in the beginning stages of this, you just have to have trust in the doctors and the protocol,” says Wendy Septembre.

Says NICU nurse Patrick McGrath: “I’ve seen miracles after miracles happen. I keep on seeing these babies come back and I’m always pleased.”