Head cooling may reduce brain damage in infants

Cooling the head with a special cap may help reduce brain damage in infants with neonatal encephalopathy, a serious neurologic condition that occurs in the first days of life, new research shows. This treatment seems to work for most infants, provided their condition is not too severe.

About 5 in 1000 infants will have neonatal encephalopathy, which is often caused by inadequate levels of oxygen in the brain. Symptoms include problems with breathing, decreased reflexes, seizures, and a lowered level of consciousness. With severe forms of the disease, the brain damage can be permanent.

Previous reports have suggested that cooling the body or just the head can help protect nerves from the damage that occurs.

"Our study suggests that, except in the most severe cases, selective head cooling soon after birth could be a (viable) treatment to reduce disability due to neonatal brain damage," senior author Dr. Alistair J. Gunn, from the University of Auckland in New Zealand, said in a statement.

The findings, which appear in The Lancet, are based on a study of 218 infants with neonatal encephalopathy who were treated with head cooling for the first 72 hours of life or with conventional care. Head cooling was achieved with a special cap that reduces the temperature a few degrees.

At 18-month follow-up, the percentage of infants who died or had severe disability in the head cooling group was 55 percent, lower, but not statistically different than the percentage in the conventional care group, at 66 percent. However, further analysis revealed that the severity of encephalopathy, as determined by electroencephalogram or EEG, determined the effectiveness of head cooling.

Head cooling did not benefit infants with the most severe EEG findings. In contrast, among infants with less severe findings, head cooling reduced the risk of death or severe disability by 58 percent. Fortunately, 172 of the 218 infants had these less severe findings.

"In the future, measurements of brain electrical activity may help us target treatment to the babies who are most likely to benefit from cooling," Gunn noted.

The study was funded by Seattle-based Olympic Medical, which markets the cooling cap as the Olympic Medical Cool Care System.

SOURCE: The Lancet, January 28th online issue, 2005.