Last Updated: Wednesday, 5 May, 2004, 15:41 GMT 16:41 UK  

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Brain cooling cuts risk to babies
 
 
The cap helped many babies 
Cooling the brain can minimise the risk of damage to babies deprived of
oxygen at birth, research has confirmed. 
International tests of a special water cooled cap for babies' heads have
produced highly promising results. 

Babies fitted with the cap were less likely to die, or to be severely
disabled. Cerebral palsy rates were cut by half. 

However, the cap, developed by an international team of researchers, did
not aid the most seriously injured. 

A lack of oxygen at birth can result from a ruptured uterus, a placenta
that peels off too early, or the rupture or collapse of the umbilical
chord. 

  "For the first time there is hope for babies who are profoundly at
risk. 

Professor John Wyatt  
It is estimated that one in 1,000 babies in the UK are affected. The
figure is much higher in the developing world. 

Up to now, no intervention has seemed to make much difference - many
babies die or develop problems such as cerebral palsy. 

Researchers at University College London Hospitals (UCLH) discovered
that damage to the brain does not occur immediately the organ is
deprived of oxygen. 

Instead, damage is the result of a cascade of chemical reactions, and
there is a window of several hours before it becomes permanent. 

Therefore, in theory it might be possible to intervene to block the
chemical chain reaction and minimise permanent damage. 

One way of doing this is to reduce brain temperature. Previous studies
have shown that reducing the temperature by 3-4°C from normal seems to
switch off many of the damaging reactions. 

Why this is so is not understood, but it may be that cooling slows down
chemical reactions, and gives the repair mechanisms found inside cells a
chance to get to work without being overwhelmed. 

The UCLH team joined forces with researchers in New Zealand, Bristol and
Seattle to put theory into practice by developing a water cooled cap for
babies' heads. 

In total, 234 babies from around the world took part in the trial. Half
received the cooling treatment, and half had standard intensive care. 

Comparison 

The cooled babies received 72 hours of treatment followed by gradual
rewarming and standard care. 

Both groups were followed up for 18 months and assessed by
paediatricians who were unaware which baby had been cooled and which had
not. 

The cooled babies showed significant benefits. There was a reduction in
both the number of babies who died and in how severely disabled they
were at 18 months of age. 

However, the babies who had the most severe electrical deficits at birth
- around 20% of the total - did not respond to cooling. 

In the trial the treatment was given up to six hours from the moment of
delivery, but there is evidence to suggest that the treatment may still
be effective if given at a later stage. 

The results suggest that for every six to eight babies suitable for
treatment with the cooling cap, one will be saved from death or serious
brain damage. 

Professor John Wyatt, head of the UCLH team, said he was "encouraged" by
the results. 

"For the first time there is hope for babies who are profoundly at
risk," he said. 

Whole body 

The Medical Research Council is currently carrying out a major trial of
the effect of whole baby cooling. 

Professor Wyatt said that it was vital that the MRC trial was completed
as it would be very important in helping to decide which approach was
best. 

He said there was still work to be done to determine the right
temperature, and the right length of treatment before cooling was
offered as a standard treatment. 

He told BBC News Online that the theoretical advantage of brain cooling
was to minimise possible side effects, such as circulation problems and
increased risk of infection. 

Simon Moore, of Action Medical Research, which helped fund the research
along with the children's medical charity SPARKS, said: "This looks like
really good news. 

"By treatment immediately after birth, babies who are at risk will have
a hugely increased chance of a life without severe disability." 

Richard Parnell, head of research and public policy at the cerebral
palsy charity Scope said the research was "interesting and exciting" but
stressed more work was needed to determine the best way to use cooling
to minimise risk. 

The trial was sponsored by Olympic Medical in Seattle, which is now
developing the cap for general medical use. 





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