Babies who are starved of oxygen during birth are at a high risk of brain injury. One example is hypoxic-ischaemic encephalopathy (HIE), which can lead to the development of cerebral palsy and bring the child significant challenges throughout their life.

Previously, there was little or nothing that could be offered to babies to stop or limit the damage from occurring. This meant that even when doctors noticed that a baby did not have enough oxygen, there was nothing they could do. It made this type of incident all the more tragic for the child and family involved.

Fortunately, a treatment method has emerged in recent years that can bring hope to babies who have sadly suffered such a traumatic start to life. This new approach, called "therapeutic hypothermia", involves a form of body cooling therapy that gives babies with moderate or severe HIE the chance to make a complete recovery. Cooling therapy is often effective at greatly reducing the severity of a brain injury caused during or after birth.

A New Treatment

The 'body cooling' treatment for babies is being offered by some UK hospitals and, based on its success, will likely expand in the coming years. It involves wrapping newborns who have been starved of oxygen in a blanket filled with fluid that reduces the baby's body temperature from the normal 37°C to 33.5°C. This is continued for the first few days of their life to induce a mild form of hypothermia to the baby, which is why the method is also known as hypothermia therapy. Doctors do not know why exactly the method works, but one theory is that the reduced temperature minimises the number of cells that die from the lack of oxygen. Lowering the normal body temperature reduces blood flow, which might account for this improvement.

When a baby's oxygen supply is cut off - for example, due to the blood supply through the umbilical cord being disrupted - the child can usually withstand it for the first 10 minutes before damage is caused to their brain. However, some medical experts are now of the opinion that the damage is not instantaneous. Giving the brain time to recover from the shock using this whole-body cooling therapy may enable the damage to be limited or even prevented altogether.

Astonishing Results

The results the method achieves are astonishing - it has saved lives and prevented major disabilities in many children since it was introduced. It was first trialled in the UK in 2009 when more than 300 babies born full-term who suffered oxygen deprivation at birth received the treatment at 33 hospitals. The researchers found that the babies were 57 per cent more likely to survive without brain injury after the therapeutic hypothermia initiated. The study came after 20 years of research into the method, but its findings represented the first conclusive proof that it could be an effective way to prevent hypoxic-ischaemic encephalopathy and help babies who have been starved of oxygen.

Baby Ella: A Case Study

Since this trial, there have been several moving cases involving babies whose oxygen supply was cut off during their birth, but who experienced little or no impact after receiving the whole body cooling treatment. One such example is that of baby Ella, who was at significant risk of severe brain damage after her oxygen supply was cut off when her mother's placenta ruptured during her birth. When Ella was delivered she did not have a heartbeat, but she was resuscitated and put on life support to enable her to breathe. Doctors then started the body cooling process, and months later Ella was a healthy baby girl with no signs of brain abnormalities, which certainly would not have been expected without the treatment.

Ella's consultant, Dr Topun Austin, a neonatologist at Addenbrooke's Hospital in Cambridge where Ella was born, told the BBC that research had shown that brain cells took 24-48 hours to die. This means that there is a window during which the brain damage can be stopped by lowering the baby's temperature. He said: “Lack of oxygen is a trigger but it doesn't happen immediately. The damage can be prevented.”

Why Would a Baby Need Cooling Therapy?

Unfortunately, there is always a risk during childbirth that something will go wrong. While most risks can be accounted for and mitigated, accidents can still happen and have significant effects. One of the most serious challenges of childbirth is the risk of HIE. While there are some factors that present an increased risk of HIE - such as premature babies or certain health issues in the mother - it can happen in any circumstance where a baby's oxygen saturation is too low.

A lack of oxygen to the baby's brain during and after birth can lead to neonatal encephalopathy, and in particular hypoxic-ischaemic encephalopathy. HIE can lead to developmental challenges for the baby and may result in cerebral palsy. This is a name for several related movement disorders and conditions that will last for the child's entire life.

As we have noted, total body cooling therapy for newborns alleviates the risk of HIE in some cases. It prevents the baby from sustaining a brain injury caused by the lack of oxygen, although it is not effective for every child.

A Major Breakthrough in Neonatal Care

Thankfully, in comparison to the large number of babies that are born every day, the number who experience oxygen deprivation is relatively few. However, because of the catastrophic impact it can have on their whole lives, the provision of this effective treatment marks a major breakthrough in neonatal care.

The specialist solicitors at JMW frequently handle cases involving children who are severely disabled, have profound learning difficulties, behavioural problems and conditions such as epilepsy because their brain was starved of oxygen during birth. Although there are some circumstances where every possible step was taken to deliver the baby safely and the incident could sadly not be avoided, there are others where serious mistakes were made that caused the baby's injury and subsequent cerebral palsy.

There is now an opportunity that this new whole body hypothermia therapy could eventually be introduced in every neonatal intensive care unit in the UK, and significantly reduce the risk of a brain injury for every baby, no matter the role of birth asphyxia or other challenges.

More Research is Needed

The cooling method is a major medical development and one that should be celebrated, but unfortunately it is not successful in every case. Furthermore, because it is a relatively new treatment, we do not have clear evidence of what the long-term effects of cooling a baby's core temperature might be. Whilst some children may have a good short-term response to cooling, more research is needed to see what the future holds for children who have had newborn cooling treatment.

For those children whose brain injury was the result of the negligence of healthcare staff, claiming the compensation they are entitled to is crucial to cover the cost of their specialist care and equipment, and to ensure they can cope later in life as they will frequently be unable to live independently.

Can HIE be Prevented?

While not all cases of HIE can be prevented, many can. This is because there are key risk factors that can be identified early, and timely interventions that can mitigate any danger. If doctors, midwives and medical staff follow best practices in maternity care, they can often minimise the risk of neonatal encephalopathy and a lack of oxygen before any kind of therapeutic hypothermia is needed.

Unfortunately, HIE is sometimes caused by failures to provide the appropriate medical treatment. It is especially frustrating when a brain injury could have been prevented - not only through neonatal cooling, but through careful monitoring of the baby's body temperature and oxygen levels during birth. If medical staff fail to monitor the baby during birth, they may fail to detect symptoms of hypoxia in time. Similarly, if they do not identify and treat maternal health conditions that increase the threat of HIE, or fail to react appropriately to complications during childbirth, this can also lead the child to develop the condition.

In these cases, hypothermia therapy may be used. However, if the child develops cerebral palsy or another condition as a result of their medical team's negligence, they will often be entitled to compensation. Contact JMW today to learn more about how we can help to get your child the help they deserve. Call 0345 872 6666 or use our online enquiry form to get in touch.