Latest neuroprotection techniques save newborns

Wendy and her husband, Ian were eagerly awaiting the birth of their first child, a little girl. The pregnancy was going as planned until Wendy’s water broke at 39 weeks of pregnancy. She noticed a heavy amount of blood and knew something was wrong. They rushed to their local suburban Maryland hospital. The baby’s heart rate fell to less than 40 beats per minute, and Wendy was rushed into surgery for an emergency Caesarian section.

Their daughter, Sydney, took two large gasps for air then her heart stopped beating. Doctors worked to resuscitate her, but she remained asphyxiated for about eight minutes. Immediately Sydney was prepared for transfer to Children’s National Medical Center’s Newborn Intensive Care Unit (NICU), the only unit in the area given the American Academy of Pediatrics’ highest-level designation, IIID. Sydney was transported via helicopter by Children’s Neonatal Transport Team, which transports more than 700 infants each year.

As a top 10 children’s hospital, Children’s was able to treat Sydney with whole-body cooling, an innovative neuroprotective technique for infants who sustain such a hypoxic ischemic insult at birth. Whole-body cooling aims to minimize brain injury in these cases. Neuroprotective strategies are coming to the forefront of pediatric intensive care medicine, where the focus is currently on detecting brain injury and offering therapies. This new technique is a multidisciplinary collaboration among the Divisions of Neonatology, Neurology, and Neuroradiology at Children’s National Medical Center.

Sydney eventually developed pulmonary hypertension, a common side effect of neonatal asphyxiation, which required prolonged mechanical ventilation and nitric oxide inhalation treatment. An MRI showed some signs of brain damage in the areas of her brain that control speech, learning and retention and hand movements. But neonatologist Stephen Baumgart, MD, is hopeful for a full recovery as infants have tremendous ability to adapt their neurological development.

Children’s seeks new treatments to preserve neurological functions in other care areas as well. Children’s Chief of Cardiac Surgery, Richard Jonas, MD, led prospective randomized surgical trials that changed heart-lung bypass procedures to limit the potential for brain damage during surgery and improve the quality of life for patients. Dr. Jonas also pioneered efforts to correct complex congenital heart defects on infants, preventing secondary organ damage.

Sydney was discharged from Children’s after 16 days in the NICU. She is now working with a local program for children with disabilities and making progress. Wendy and Ian are hopeful that their daughter will grow up to be a happy and healthy girl, but for now, they are busy adjusting to life with a new baby.

“I love being a mom and having Sydney at home,” gushes Wendy. “She’s doing so well now that to look back on everything just seems so surreal.”

“Whole-body cooling is the first neurological protective therapy proven effective for treating injured neonates and gives some of our tiniest patients a better than 50 percent shot at a normal life,” says Dr. Baumgart. “We aspire to investigate and develop other neuroprotection strategies through further research and clinical development.”