Cool caps can help prevent brain damage in newborns

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A plastic bathing cap filled with cool water can help prevent brain damage in newborn babies. The affliction devastates hundreds of families each year and is the commonest cause of multimillion-pound lawsuits against the NHS.

A plastic bathing cap filled with cool water can help prevent brain damage in newborn babies. The affliction devastates hundreds of families each year and is the commonest cause of multimillion-pound lawsuits against the NHS.

The polythene hat, worn for three days immediately after birth, saved one in six babies who suffered oxygen deprivation at birth from death or lifelong disability in a four-country trial.

Doctors believe there is further potential to save more babies by refining the treatment. Studies are under way into total body cooling, which could be simpler to control.

Brain damage caused by oxygen deprivation at birth affects 600 to 700 babies a year in the UK. The lifelong costs of care for a severely brain-damaged baby are up to £5m.

Often there is no warning of a problem until the last moments of pregnancy. The umbilical cord may become trapped round the baby's head or the womb may rupture down a previous Caesarean scar. After the baby is born the oxygen supply is restored, but it is too late. Any restriction of blood flow to the brain was thought to cause damage within minutes.

The results of the study, published online in the Lancet today, demonstrate for the first time that the damage may not be irreversible. Research a decade ago showed that when the brain was starved of oxygen, damage did not occur immediately; there were a few hours when the effects are treatable.

By cooling the brain, doctors believe they can interrupt the "chemical cascade" triggered by the lack of oxygen which leads to brain damage.

John Wyatt, professor of neonatology at University College Hospital, London, said: "What this confirms is that the brain damage is not irreversible at the moment of delivery. This is the clearest evidence that intervention at birth can improve the outcome." For the trial, researchers in hospitals in Canada, the US, New Zealand and the UK selected 234 babies who were deprived of oxygen at birth and at high risk of brain damage. The cool caps were fitted within hours of birth, lowering the temperature by three to four degrees and removed after 72 hours.

When the babies were examined 18 months later, the results showed the proportion who had suffered severe disability or death was reduced from 66 per cent in the group given conventional care to 55 per cent in those treated with the cooling cap. This was improved to 48 per cent, achieving statistical significance, when the one-fifth most severely affected babies with least chance of recovery were excluded.

Professor Wyatt said: "What is encouraging is the larger group of whom one in six showed benefit. For the past 40 years, it has been paediatric orthodoxy that babies should be kept warm. We are not changing the advice - it is very important babies are kept warm - but this does turn conventional wisdom on its head."

Professor Andrew Whitelaw from the University of Bristol, another of the researchers, said: "We need to get further information on the timing and methods of cooling, as well as which babies are most suitable for treatment, before cooling becomes the standard care for oxygen deprived babies."

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