Neonatal Therapeutic Hypothermia, also known as “Cooling Therapy” is a treatment for newborns that lack oxygen due to birth complications.
Infants sometimes lack sufficient oxygen at birth due to blood loss or other complications during delivery. This severe oxygen deficiency, known as birth asphyxia or hypoxic-ischemic encephalopathy, can often lead to brain damage, and even death. Infants who suffer from this brain damage can end up with life-altering impairments or disabilities including cerebral palsy, cognitive impairment, or hearing and vision loss. Even without detectable brain damage, children who’ve had birth asphyxia are at increased risk for learning disabilities, language delays and memory deficits later in life.
Fortunately, the National Institutes of Health (NIH) found that a cooling treatment called Neonatal Therapeutic Hypothermia given to newborns can reduce the risk of death and disability. The treatment aims to slow or stop damaging effects of birth asphyxia by lowering the infant’s body temperature for up to 72 hours. The technique involves placing the newborn on a waterproof blanket that contains cool circulating water which can reduce the infant’s temperature as low as 91.4 degrees Fahrenheit. After three days of the treatment, the caregivers allow the newborn’s temperature to return to normal.
The results of this treatment have shown a reduced risk of death and disability by ages 18 to 22 months as compared to routine care without the treatment. A NIH of the treatment found a significantly lower mortality rate in the hypothermia group (28%) compared to the usual care group (44%). According to the NIH, the researchers also calculated the number of deaths and cases of severe disability as a single combined outcome. Severe disability involved motor function, cognitive ability, and vision. The combined rate was 41% for the cooling group, compared with 60% for the usual care group. Rates of cerebral palsy, blindness and epilepsy were similar between the two groups.
Following the NIH study, the internationally acclaimed Cochrane Library published a meta-analysis of cooling therapy studies, concluding, “There is evidence that induced hypothermia (cooling) of newborn babies who may have suffered from a lack of oxygen at birth reduces death or disability, without increasing disability in survivors.” Furthermore, it recommended that “parents should expect that cooling will decrease their baby’s chance of dying and that if their baby survives, cooling will decrease his/her chance of major disability.” When newborns with birth asphyxia or hypoxic-ischemic encephalopathy are not given this treatment in time or at all, the consequences, as mentioned above, are devastating. This treatment has been adopted as the standard of care for newborns with oxygen deficiency due to its promising results.
Nationally recognized birth injury lawyers and Feldman Shepherd attorneys Daniel S. Weinstock , G. Scott Vezina and Carolyn M. Chopko recently represented a family whose newborn was not treated with neonatal therapeutic hypothermia soon enough and will, therefore, suffer brain damage and disability for the rest of her life. They obtained a $5.3 million settlement in this case which took place in rural Florida and involved a failure of the pediatric team to timely transfer the baby to a regional hospital where she could receive body cooling therapy in order to minimize the impact of her birth injury. Feldman Shepherd is unaware of any previous cases in the country where a recovery has been made in a case involving negligent failure to perform body cooling.
The baby was born significantly depressed, at a woefully underinsured birthing center in rural Florida. She was immediately transported to a local hospital that had a pediatrician on staff but no neonatologist and no ability to perform body cooling therapy. According to his testimony, the pediatrician in charge of the baby’s care was generally aware of body cooling therapy but at the time was under the impression that it was a new and experimental treatment. Accordingly, he waited overnight before having the depressed baby transported to a regional hospital that was capable of providing a higher level of care. Unfortunately, body cooling therapy must be initiated within a few hours of birth, and the pediatrician’s failure to order the transport immediately deprived this baby of an opportunity to receive this treatment.
Body cooling was considered investigational in its early stages, but by the late 2000s, its benefits had been fairly conclusively established in reducing and even preventing permanent brain injury to term newborns suffering from severe acute birth asphyxia. This child, born in 2014, was absolutely a candidate for this therapy that had become fairly standard by the time she was born. Attorneys Weinstock, Vezina and Chopko put together a compelling argument that the failure to transfer her to a regional hospital early enough to receive this therapy was negligent and significantly contributed to her outcome of cerebral palsy.