The only time I read magazines (apart from horsey ones) is during my break at work. We seem to have an endless supply of the crappy ‘chat’ magazines with stories that seem to focus upon affairs, bizarre health issues, birth stories and extreme weight loss.
A couple of weeks ago I read a story in one of these magazines that had a headline along the lines of “Doctors Froze my Baby to Save Him.”
I always take stories with sensationalist headlines with a pinch of salt, especially if they involve anything medical.
I distinctly remember reading a story where a nurse had supposedly cut off a baby’s finger, which then couldn’t be reattached.
Clearly any kind of injury of this type is unacceptable and negligent on the part of the healthcare professional and they should be disciplined accordingly.
However, when I read the actual story it transpired that the reason the ‘finger’ couldn’t be reattached was because the piece that was cut off was so small that the plastic surgeon didn’t see point in trying.
So I was pretty certain that frozen baby story wouldn’t involve any sort of freezer and what would actually be about but I thought I’d read it just to check.
It was indeed an article about a baby who had been ‘cooled.’
Neonatal therapeutic hypothermia, commonly known as ‘cooling’ aims to protect the baby’s brain by reducing their core temperature by 3-4 degrees.
Cooling is a rather misleading term as the babies don’t actually get cold and they’re certainly not frozen. Reducing their core temperature gives us the protective effect but it’s not a big reduction and the babies still feel warm.
It’s used for full term babies who’ve been starved of oxygen late in in the pregnancy, during labour or shortly before birth. This can be due to severe bleeding, cord compression, placental insufficiency or abruption.
Sometimes the cause is completely unknown.
Being oxygen deprived can cause catastrophic brain damage unless the oxygen supply to the brain is restored as quickly as possible. The sooner the oxygen supply is restored, the milder the injury will be, if there is even an injury to the brain at all.
But once the damage has been done it is almost impossible to reverse.
Cooling helps to prevent further brain injury from occurring as even once the brain starts to recieve oxygen again the initial shock to the brain can cause it to become severely inflamed. This is a similar to the processes that occur during a severe allergic reaction, except it is the brain that if affected, not the airways.
Cooling therapy halts the inflammation and the damage it has the potential to cause but it can’t repair any damage that has already occurred before the baby was cooled.
I find cooling babies some of the most difficult and upsetting to care for, not only because they are so sick but because they are also full term.
Up until the moment that hypoxic insult occurs, depriving the fragile brain of oxygen the mum has usually had a normal, uneventful pregnancy and labour has often been straight forward.
Both parents are expecting to welcome a beautiful, healthy baby into the world.
But sometimes, at almost the last minute it goes so catastrophically wrong and often we don’t know why.
We don’t know why placentas suddenly rupture or umbilical cords snap and if we don’t know why then we can’t prevent it from happening again and again
Cooling babies are some of the sickest babies that we care for and there are occasions that, despite all our interventions the injury is just too severe and the brain is so damaged that it can’t support even the most basic functions.
Functions vital to keeping the body alive.
In the worst cases we do lose these babies.
To start cooling we wrap the babies in a cooling jacket which is filled with warm water to bring their core down to the optimum cooling temperature and maintain it.
The babies are cooled for 72 hours, during which time they are paralysed and sedated with drugs and their breathing is taken over by a ventilator.
We also make sure they have constant pain relief.
There’s no firm evidence that cooling or ventilation is painful but we don’t want to take that chance.
Cooling babies tend to have a large amount of equipment and monitoring attached to them. Although they’re quite large compared to the tiny, premature babies they look so small, dwarfed by the machines keeping them alive.
We monitor their heart rate, breathing rate and temperature both internally and externally.
We insert fine needles into the scalp to monitor the activity of the brain.
We run fluids and medications into their fragile veins to relieve any pain, support their blood pressure and provide the liquid and calories that they should be getting from milk.
But they’re far too ill to feed.
They lie completely still.
Their little arms and legs floppy.
Their faces pale.
Their eyes closed.
The only movement is the air being forced in and out of their chests.
We talk to them softly, changing their position every few hours so that they don’t get sore from lying in the same place.
They look so peaceful
And yet so ill.
Trying to explain to parents how and why their baby is being cooled is often difficult. It’s such a lot of complex information to take in for parents who had no warning that their child would be so desperately sick.
We encourage them to touch their baby, to hold their little hands and feetfeet, stroke their faces and let their baby know that they are there.
I always tell parents that their presence and their touch is just as vital as anything that we do.
They’re usually surprised that their little one still feels warm and sometimes ask us if the cooling jacket is working properly.
After the three days of cooling, by which time all we slowly warm the baby up. The cooling jacket is programmed to maintain the baby’s core at specific temperatures and they will wear the jacket until their temperature normalises.
They look like little animals coming out of hibernation.
Their fingers start to wiggle and their limbs begin to twitch.
As they slowly get warmer and we reduce the sedatives they usually start to breathe for themselves.
Usually, but not always.
Its very difficult determine the extent of the brain injury until several days or weeks until after it occurred and we often don’t know exactly how it will affect the baby until years later.
There are signs we can look for to give us an idea whether the damage is mild, moderate or severe and we have equipment that can monitor the electrical activity of the brain and show whether the activity looks normal.
But with many babies we just have to wait and see.
We’ve used all the interventions and equipment at our disposal and once the baby has been rewarmed there is nothing else we can do.
Instead we watch them for any signs that indicate something isn’t right.
Very stiff or floppy limbs
Jerky or repetitive movements such continual lip smacking.
Eyes not focusing or rolling back in the head.
This is incredibly difficult for the parents; knowing that their child’s development is likely to be affected but very little else.
We can’t tell them if their child will be able walk or talk normally.
Whether they will be able to see or hear.
We just don’t know.
Research is constantly being carried out to determine why hypoxic insults occur and advances and improvements to cooling are being made all the time.
More babies than ever before are surviving hypoxic insults with minimal, if any brain damage and leading normal lives.
But it’s still not enough.