Therapeutic Hypothermia

June 24, 2021 By Michael Prendergast, MD, Mass General Hospital, and Neonatal Associate Medical Director, Boston MedFlight 

One of the most familiar principles in newborn care is the practice of keeping babies warm. However, in newborns who have the potential for brain injury after birth, some are treated with a therapy which intentionally cools them down. 
 
‘Therapeutic hypothermia’ (or cooling therapy) significantly improves these babies’ chances of survival and reduces the risk of major disability. The therapy is delivered by a specialized cooling blanket in which the baby is wrapped. This is controlled by a thermometer continuously monitoring the temperature and adjusting itself automatically to gradually lower the baby’s temperature down to 33.5°C (92.3°F). This process is known as ‘active cooling.’ In order to be most effective, cooling should be started as early as possible after birth and continued for 72 hours. A delay in starting therapy can result in further brain injury.
 
Due to the specialized nature of this therapy, affected infants are cared for in certain neonatal intensive care units (NICUs) with expertise in this condition. Where cooling therapy is not available at the birth center, affected infants are immediately transferred to specialist NICUs for therapy. While awaiting transfer to one of these NICUs, ‘passive cooling’ or simply removing external heat sources such as blankets and warming lamps from the newborn can be initiated. While passive cooling is a helpful short-term approach, it is less effective than active cooling and may even be harmful (babies can become over-cooled).
 
To address this critical care need in these extremely vulnerable patients, and as a result of a collaboration between Controlled Risk Insurance Company (CRICO) and Boston MedFlight, CRICO awarded grant funding to enable BMF to provide active cooling therapy as a standard feature for all neonatal transports. As of May, our crews can now bring this therapy to the baby’s bedside, where it can be initiated and continued throughout the onward journey to the NICU. By providing this time sensitive therapy at an earlier juncture, Boston MedFlight is making a critical contribution to protecting the brains of affected newborns.