Cooling therapy in Iowa hospitals pushes limits for newborns
Cedar Rapids, Iowa City hospitals use technique
Deegan Mizaur’s heart-melting smiles, sweet babbles and unending curiosity belie his traumatic start in life.
Born without a pulse during an emergency C-section in October, Deegan was revived and immediately placed in a cooling blanket in hopes of minimizing potential disabilities.
“They didn’t think he’d survive the first night,” said his mother, Graham Ziese, 30, of Mechanicsville. “The first week was very touch and go.”
Ziese and her fiance, Kyle Mizaur, credit the medical team at St. Luke’s Hospital and the systemic hypothermia treatment, known as total body cooling, for saving their son.
The therapy has been used in various hospitals for more than a decade, with clinical trials in Iowa and elsewhere exploring the effects of longer time frames and colder temperatures to determine the best care for newborns in need of the treatment.
Dr. Dennis Rosenblum, St. Luke’s Neonatal Intensive Care Unit medical director, said the hospital has used the therapy five times in the past two years.
Pediatric cooling blankets lower the newborn’s body temperature to 92.3 degrees (normal is 98.6 degrees) for three days. The baby is slowly rewarmed to a normal temperature.
Rosenblum said cooling the body slows the baby’s metabolism, decreasing the rate of brain cell death caused by lack of oxygen.
Hypothermia also has been used with adults for conditions such as stroke and cardiac arrest.
Studies have shown the treatment not only decreases the risk of severe physical and mental disabilities, such as cerebral palsy, but can save lives. All of the newborns treated so far at St. Luke’s have survived.
A May article in the New England Journal of Medicine noted that long-term studies showed the rate of death and lower IQ scores was lower among children who had undergone whole-body hypothermia than among those undergoing usual care, though differences were not statistically significant.
The article said the treatment resulted in lower death rates and did not increase rates of severe disability among survivors.
Just last week, the online Annals of Emergency Medicine reported the technique was used with a pregnant mother who suffered cardiac arrest. She delivered a healthy baby boy 19 weeks later.
Rosenblum said out of 1,000 live births, one to six infants have hypoxic-ischemic encephalopathy, a condition in which the brain does not receive enough oxygen.
“It’s not an everyday occurrence,” he said.
Full-term babies that have to be revived; those with seizures and low muscle tone are among candidates for treatment.
The condition has numerous causes, including mothers with severe bleeding or diabetes, infections and babies that outgrow the placenta.
Dr. Jonathan Klein, medical director for the Neonatal Intensive Care Unit at University of Iowa Children’s Hospital, said the hospital has used the treatment for 46 babies since July 2007.
Klein said four of the babies have died, and overall, death and disability rates have been 35 percent, compared to an expected 64 percent without the treatment.
“It’s such a devastating thing when it does occur,” Klein said. “This is the first breakthrough we’ve had with treating this condition.”
UI Hospitals are in clinical trials that study using the treatment as long as five days or with temperatures as low as 89.6 degrees.
Doctors have a six-hour window to induce hypothermia using standard treatment, but the studies also examine outcomes when cooling is delayed beyond six hours.
“We know it’s safe,” Klein said of the expanded parameters. “The question is, will it improve the outcome.”
Deegan spent 26 days at St. Luke’s NICU. He went home using oxygen, but his mother said other than an unrelated eye condition, he is surpassing expectations.
The 9-month-old towhead has been crawling and was “kicked out” of physical therapy because he was doing so well, said Ziese, who works at We Teach 2 child care in Cedar Rapids.“Every time they’ve done a test it’s been normal,” she said. “My big hope is that he can go to school like a normal kid.”