More than 1000 children die or suffer permanent brain injury every year in the UK because of shortage of oxygen around the time of birth. Tragedy can strike without warning, and often following normal healthy pregnancies. If the baby survives major problems include severe cerebral palsy, learning difficulties and epilepsy. The problem has been known about for many years but until now no treatment has been found which can prevent or minimise the damage and the long-term consequences.
A group of doctors and scientists at University College London and University College London Hospitals NHS Trust, using state of the art brain scanning techniques, has discovered that the brain damage doesn't occur immediately at the time of delivery. There is often a window of several hours before the injury becomes permanent; in other words there is a brief window of time when protective treatment might be effective.
With support from medical charities SPARKS and Action Medical Research, studies at UCL, Bristol and other research centres around the world have shown that cooling the newborn brain by several degrees is highly effective in protecting brain cells.
A Coolcap device for head cooling after birth has been designed and tested by a research team including Professor Wyatt at UCLH NHS Trust, Professor Gluckman from New Zealand, and Olympic Medical, a Seattle based medical technology company. Using a computerised controller, cold water is circulated through the cap, reducing brain temperature by several degrees. At the same time heating is applied to the body to prevent the central body temperature falling too low. Cooling is maintained for 72 hours and intensive care is maintained throughout the treatment.
Professor John Wyatt said today that the international trial results should give hope for the parents of new-borns who might suffer a lack of oxygen at birth. "About one in every 1,000 newborn babies are at risk of death or brain damage from oxygen-deprivation during the birth process. The rate is much higher in countries with limited resources. Those who survive can be left with heartbreaking conditions such as cerebral palsy or severe intellectual impairment."
The randomised study, conducted in 24 centres and involving 234 newborns, shows that the CoolCap can reduce the rate of death or severe disability. The key findings are:
- 18 months after birth, there was a significant reduction in severe disabilities among those treated with the CoolCap.
- Brain wave analysis used at birth enabled the researchers to identify those babies who had the best chance of responding to treatment. In this group, the number who died was reduced from 39% to 25% and the incidence of movement problems among those who survived was reduced by 60%.
- In the most severely affected babies, treatment with the CoolCap showed no benefit.
Professor Wyatt said: "Further development is required before this treatment can be made generally available in major hospitals. It is vital that further trials of cooling treatment are completed to find the optimum way of providing cooling after birth."
John Shanley, chief executive of SPARKS, commented: "We are delighted the groundbreaking research SPARKS has funded with UCLH and at Bristol has produced such positive results.
"Our congratulations to all the research teams and Professor John Wyatt.
"This is a major step forward and SPARKS is committed to continuing to raise funds to take this vital research on to the next stages and establish Europe's first baby brain protection and repair unit".