Newborns feeling breathless? Check for hypoxic ischemic injury

Bengaluru: Recently, an infant who wasn’t crying and whose heart was not beating properly, accompanied by occasional fits in the form of jerky movements of both arms and legs, was referred to Rainbow Children's Hospital, Marathahalli. There a team of pediatricians revived the baby in the ambulance and immediately started total body cooling using the special machine and the cooling jacket.

"The baby was suffering from Hypoxic ischemic injury (HIE), which can be scary for the newborn as it results in children developing a range of mild to severe disabilities. These include difficulties with movement and tone (commonly referred to as Cerebral Palsy), feeding problems, hearing and visual difficulties and seizures etc. The range of outcomes depends on how severe the injury was; the areas of the brain affected (different areas of the brain control different functions), stage of brain development at the time of injury and also the treatment offered," says Dr Prathap Chandra, neonatal consultant, Rainbow Hospital.

Dr Rajath Athreya, neonatal consultant, Rainbow Hospital, explained, "Our brain needs a constant supply of oxygen and nutrients carried by blood, to nourish it. If this blood supply is interrupted or there is insufficient oxygen in the blood, the brain becomes oxygen-deprived. Even if this occurs for a short time, the brain may be injured. Hypoxic ischaemic injury (HIE) is a type of damage to the newborn brain. Hypoxic means not enough of oxygen. Ischemic means not enough blood flow. Encephalopathy means abnormal brain function. This situation can arise before, during or immediately after birth. Failure to initiate or sustain respiration after birth is a simpler way of defining HIE."

Thanks to the Cooling or Therapeutic Hypothermia (TH) and total body cooling, the newborn baby was cooled to 33.5-degree centigrade for three days and subsequently re-warmed slowly over the next 12 hours.

"Many of these babies can be saved if the hospitals are equipped with Therapeutic Hypothermia (TH). The TH is the treatment of choice for moderate to severe HIE. By this medical intervention, the Cooling/TH reduces the amount of ongoing damage to brain cells and reduces the cell death. There is very good evidence that this treatment will increase the baby’s chance of survival and that among the surviving babies, cooling will decrease his/her risk of major disabilities," explains Dr Prathap.