New device keeps newborns cool en route to intensive care

CALGARY – Newborns in southern Alberta who have been deprived of oxygen at birth and born away from advanced care centres will soon have improved chances of surviving without sustaining brain injuries.

Foothills Medical Centre (FMC) is one of the first care facilities in the country to purchase a portable transportation cooling device, which is expected to be more reliable in maintaining needed temperatures during transport than current methods.

Since about 2008, doctors have used cooling blankets and other devices to bring these babies’ temperatures to 33.5 degrees for 72 hours, in order to prevent brain damage. (Normal body temperature is about 37 degrees.)

The reduction in temperature, called therapeutic hypothermia, helps prevent further damage to fragile brain tissue and promotes healing.

In current practice, babies who are born away from an advanced care facility are kept cool on transport either by turning off heating sources (passive cooling) or surrounding them with cooling gel packs.

“With those methods, it can be difficult to maintain a stable temperature,” says neonatologist Dr. Khorshid Mohammad, the neonatal neuro-critical care project lead who spearheaded the purchase of the transportation cooling device.

“The period immediately following birth is critical. We have about a six-hour window to lower these babies’ temperatures to prevent neurological damage. The sooner we can do so, and the more consistent we can make the temperature, the more protective it is and the better their chances of surviving without injury.”

Kathryn Kaminski and Curtis de Vries can attest to the benefits of therapeutic hypothermia. Shortly after their daughter Tegan was born by emergency caesarean section, doctors discovered the girl had lost a lot of blood and was having difficulty breathing.

“They didn’t know why Tegan had lost blood but they thought she was a good candidate for cooling,” Kathryn says. Tegan was transferred from Peter Lougheed Centre to the neonatal intensive care unit (NICU) at Foothills, where she was kept at 33.5 degrees for three days.

Doctors initially feared Tegan might not come through without neurological damage but today she’s a happy, healthy one-year-old and ahead of her developmental milestones.

“We’re so grateful for the care she received,” Kathryn says. “Dr. Mohammad and the team of doctors and nurses in the NICU were so amazing – we owe them her life.”

Tegan and her parents have since raised money and supplies for the Foothills NICU.

The new transportation cooling unit will be installed on a portable incubator cart that can be dispatched with a care team anywhere in southern Alberta, either by ground or air.

If it proves as effective as doctors anticipate, Dr. Mohammad says his group will share the results with other referral hospitals in the province for consideration.

About 65 per cent of babies are born outside facilities that have neonatal intensive care units, where care providers have the capability to implement therapeutic hypothermia.

The NICUs at Foothills Medical Centre and Alberta Children’s Hospital are also among the first centres in Canada to monitor cooled babies with continuous video EEG (electro- encephalogram), so doctors can respond to seizures that might not be outwardly visible.

In Calgary, about 40 newborns undergo therapeutic hypothermia every year. Of the approximately 50,000 babies born in Alberta each year, about 500 term and near-term babies are at risk of brain injury due to oxygen deprivation around the time of delivery, despite careful monitoring.

The neonatal neuro-critical care team in Calgary is working on standardizing care guidelines for babies at risk. These will include practices such as therapeutic hypothermia, as well as other protective strategies starting from pregnancy all the way to followup in a specialized clinic at Alberta Children Hospital.

The cost of the device is $35,000. It and the new Neuro-Critical Care program are made possible by community donations through the Alberta Children’s Hospital Foundation.

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

-30-