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Selective Head Cooling Used as an Intervention

Technique Used in Term Infants with Early Moderate to Severe Encephalopathy

New York (Jun 25, 2009)

In two large multicenter studies, selective or systemic cooling by 2 to 3 OC has been shown to reduce the extent of evolving brain injury in high-risk term infants. Receiving FDA approval in 2006, the Cool-Cap is designed to provide selective head cooling with mild below normal body temperature cooling in term newborns born with moderate to severe hypoxicischemic encephalopathy. In 2007, the Divisions of Newborn Medicine and Child Neurology at the Komansky Center for Children's Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center developed a practice plan to treat high-risk infants with the device.

Baby wearing head cooling cap

The Cool-Cap works by circulating water through the fitted cap and maintaining the cap water at an operator-specified temperature. Treatment was instituted for these infants within six hours based on the following criteria:

  • a sentinel event during labor
  • prolonged depression at birth with the need for resuscitation
  • evidence of severe fetal acidemia (cord arterial pH < 7.00), coupled with early clinical and/or EEG assessment of moderate to severe encephalopathy

"We have observed favorable outcomes in infants with moderate encephalopathy, whereas those with seizures and/or severe encephalopathy upon presentation are less likely to be affected by cooling," said Jeffrey M. Perlman, MB, ChB, Division Chief of Newborn Medicine, Department of Pediatrics, NewYork-Presbyterian/Weill Cornell, and Professor of Pediatrics, Weill Cornell Medical College.

Patient Outcomes to Date

Since May 2007, Dr. Perlman and his colleagues have treated 40 term infants, 39 of whom have been transferred from hospitals in the New York metropolitan area. The mean time to initiating cooling was 4.7 hours. The presence of encephalopathy was categorized as moderate (n=18) and severe (n=22); clinical and/or EEG seizures were essentially universal, and 50 percent were in status epilepticus (a continuous state of seizure) during cooling. A favorable short-term outcome of normal development has been noted in 72 percent with moderate encephalopathy and 40 percent with severe encephalopathy.

"These preliminary findings support prior data indicating that selective head cooling is an exciting intervention with the greatest impact in those infants with moderate encephalopathy, but surprisingly also in a substantial number who present severe findings," said Dr. Perlman. "We attribute our early success to a coordinated and dedicated approach to care that includes our neonatologists, neurologists and nursing staff. Further research will be critical to delineate additional strategies to enhance outcomes."

Faculty Contributing to this Article:

Jeffrey M. Perlman, MB, ChB, Division Chief, Newborn Medicine, Department of Pediatrics, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Professor of Pediatrics, Weill Cornell Medical College

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