Stanford Medicine Newsletter Updates For the Local Community

Brain trust

Preventing neurological damage in newborns  

Deprived of oxygen at birth, Jackson Thomas underwent controlled hypothermia at Packard Children's to help him avoid brain injury. Diane Powell is a nurse in the hospital's neonatal intensive care unit.

   

Lucile Packard Children’s Hospital has launched an ambitious effort to protect premature and dangerously ill infants from brain injury.

The new Neuro NICU, consisting of six beds in a dedicated room in the neonatal intensive care unit, will provide specialized neurological care to at-risk babies, including those who are premature, suffer early infections, have birth defects or were deprived of oxygen during labor and delivery.

Packard Children’s is one of a handful of hospitals in the country with a unit of this kind, which offers advances in treatments and technologies that allow physicians not only to keep fragile babies alive but also to reduce their risk of suffering neurological problems.

Better outcomes

“Survival rates of critically ill premature and term babies are now quite robust, but we are realizing that some of these surviving babies have developmental problems,” said neonatologist Krisa Van Meurs, MD, the unit’s medical director and a professor of pediatrics at the School of Medicine. Fortunately, new neurologic research has provided a diverse set of tools for improving vulnerable infants’ developmental outcomes and giving them the best chance at a strong start in life, she said.

“The challenge and exciting thing about treating these tiny babies is that the brain is developing on a day-by-day basis,” said Courtney Wusthoff, MD, a neonatal neurologist who arrived at Packard Children’s last September to help launch the Neuro NICU. With advances in research and technology, she said, “we have more and more options for interventions.”
In addition to bringing Wusthoff on board, the hospital has purchased a wide array of new equipment for diagnosing neurologic problems and monitoring babies’ brains and is providing specialized training for all its NICU practitioners on the latest research and treatments in infant neurology.

Chilling the body

Heather Thomas, whose family has benefited from the service, arrived in labor at a San Jose hospital in early 2012 and was found to have suffered a placental abruption, a naturally occurring complication in which the placental lining had separated from the uterus. The baby was not getting oxygen and needed to be delivered immediately. But after the delivery, baby Jackson did not breathe. He had a seizure within a minute of his birth.

After Jackson was resuscitated, a physician asked Heather and her husband, Gary, to consider transferring their son to Packard Children’s to receive controlled hypothermia, a recently developed treatment for preventing brain injury after oxygen deprivation. In this procedure, the infant is placed on a blanket latticed with tubes that carry cool water. The baby’s body is cooled to 33.5 degrees Celsius for three days. Research conducted at Packard Children’s and elsewhere has shown that, if begun within six hours of birth, cooling slows damaging metabolic processes and gives the brain time to heal.

“Until relatively recently, we could only provide supportive care for full-term babies who suffered brain injury in the labor process,” Van Meurs said. “About 25 percent of neonatal mortality is due to birth asphyxia, so controlled hypothermia has the potential to have a big impact.” Packard Children’s participated in one of the earliest clinical trials of hypothermia and has offered it since 2000, she noted.

Inside perspective

After Jackson’s body temperature was returned to normal, he received a magnetic resonance imaging scan to check for signs of brain damage. Use of MRIs for newborns’ brains is also innovative and provides a noninvasive way to detect brain injuries.

“There were no signs of brain damage,” Heather Thomas recalled. “We burst into tears.”

During Jackson’s hospital stay, the Packard Children’s team also monitored his brain with a modified electroencephalogram technique tailored to infants. Brain monitoring technologies allow caregivers to check a baby’s brain-oxygen levels and detect seizures.

“In the past, it’s been assumed that you could tell just by looking if a newborn was having a seizure,” said Wusthoff, an assistant professor of neurology. But it turns out that 80 to 90 percent of seizures in this age group cause no outward changes. “Newborns’ brains are not developed enough to show on the outside what’s happening on the inside.”

Fortunately, Jackson had no more seizures. Now 17 months old, he loves to play with his big brother, totes his favorite toy shark everywhere and shows no signs of developmental problems.

Growing impact

In addition to the techniques that helped Jackson, patients in Packard Children’s Neuro NICU benefit from multidisciplinary care by clinicians in neonatology, neurology, neurosurgery, developmental medicine, neuroradiology and psychiatry. And patients’ families receive consultations with social workers and other services to assist with practical concerns during their baby’s hospitalization.

Perhaps the biggest benefit of the Neuro NICU is that all NICU caregivers are receiving more training and experience in caring for infants’ brains. “We’re heightening awareness of babies’ neurologic needs for everybody and giving them the best chance possible to start life strong,” Wusthoff said. “And the best part is knowing that the impact can be so huge. We’re enabling a lifetime of better outcomes for infants and their families.”

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