National Institute for Health and Clinical Excellence (NICE)
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'Brain-cooling' treatment can save newborn babies deprived of oxygen from severe disability and death
A procedure which involves “cooling” newborn babies who are at risk of severe disability or death due to oxygen deprivation, has been deemed “safe and effective” enough for NHS use, says the organisation responsible for setting the standards for good healthcare.
Every year in the UK more than 1,000 otherwise healthy babies born at full term die or suffer brain damage caused by a lack of oxygen at birth or during labour. Babies who do survive can be left with lifelong disability such as cerebral palsy.
One of the treatments that can help minimise the risk of this happening involves healthcare staff lowering the temperature of the baby shortly after birth, by cooling their body using a blanket or mattress filled with cooled air or fluid, or their head using a special cooling cap. Cooling slows down the rate of cell damage in the brain.
The treatment is currently available in many neonatal intensive care units in the NHS. However the evidence of how well it works or how safe it is had never been collated and analysed on a national scale before. This has meant that the risks and benefits of the treatment, including the extent to which it can improve outcomes compared with standard intensive care treatment, have not been well understood.
The National Institute for Health and Clinical Excellence (NICE) has therefore reviewed the research published in this area and produced guidance for the NHS outlining the circumstances in which it can be offered for these vulnerable babies.
Professor Bruce Campbell, Chair of the Interventional Procedures Advisory Committee which produced the guidance for NICE said:
“Having analysed the evidence, it is clear that therapeutic hypothermia is better than standard intensive care treatments at reducing the risks for carefully selected newborn babies who have been deprived of oxygen. It has been shown to decrease their chance of dying or of developing severe neurological damage.
“Therapeutic hypothermia does, however, have some risks and possible complications, such as localised bleeding or infection. It is therefore very important that it is only carried out by specifically-trained staff and in units that are accustomed to looking after severely ill newborn babies. We also expect healthcare professionals to record the details and outcomes of all babies who have this treatment so that we can learn more about it. We would like to know more about its long term benefits and specifically which patient groups it is likely to help the most, because not all babies will benefit.”
To support this clinical audit, NICE is encouraging healthcare professionals to record the details of babies undergoing therapeutic hypothermia onto a national register called the UK TOBY cooling register, which has been funded by the Medical Research Council.
Dr Catherine Elliott, Head of Clinical Research Support at the Medical Research Council said:
“This guidance is a significant step in a very long journey of medical research into this area. It’s a shining example of how the MRC’s work, alongside the work of other scientists, doctors and academics, can impact clinical practice and ultimately save lives. It’s only with long term research funding, that stretches through from the laboratory bench to the patient’s bedside, that these kinds of results can be achieved.”
Mr John Shanley, Chief Executive of Sparks said:
“Sparks is very pleased to endorse the NICE recommendations. We are proud to have contributed towards this through the extended funding we have committed to neonatal cooling at research centres in Bristol and London.
“Since 1996 Sparks has committed nearly £1.5million towards infant cooling related projects, including the development of the ‘Coolcap.
“The NICE recommendations should result in the development of a better all-round understanding of a birth trauma that affects around 1,000 babies a year in the UK alone and can result in lifelong conditions such as cerebral palsy and epilepsy.”