Montreal’s Sainte-Justine Hospital has a new approach to therapeutic hypothermia

A new approach developed by a team at CHU Sainte-Justine makes it possible to determine much more quickly what awaits babies treated with therapeutic hypothermia.

The researchers found that the use of two complementary technologies—an electroencephalogram and an optical neuromonitoring system—makes it possible to accurately assess the severity of babies’ brain injuries as early as day two, directly at the bedside.

The previous approach consisted of waiting until the end of therapeutic hypothermia, after five days, to perform magnetic resonance imaging, which required moving the fragile newborn out of intensive care.

Therapeutic hypothermia is the only approach proven effective in limiting the neurological damage suffered by babies who are deprived of oxygen at birth, a medical condition called hypoxic-ischemic encephalopathy.

“Therapeutic hypothermia lowers the baby’s body temperature and slows brain activity to reduce the risk of further damage,” explained Dr. Elana Pinchefsky. “Studies have shown that this reduces the risk of death and long-term developmental difficulties.”

Therapeutic hypothermia is a common practice used in all major hospitals, emphasized Professor Mathieu Dehaes.

Most of the parameters governing it, however, are derived from studies conducted on animals, “and it is therefore very important to conduct clinical studies on babies,” he said.

“We wanted to arrive at a prognosis for the baby’s short-term development,” explained Professor Dehaes. “We wanted to be able to monitor the brain health of the baby being treated, to be able to predict who will be at higher risk of developing aftereffects after the therapy.”

The parameters reported in the study, he added, make it possible to predict the presence or absence of brain damage when the baby undergoes an MRI after therapeutic hypothermia.

At the moment, said Dr. Pinchefsky, it is very difficult to distinguish between “mild” and “moderate” cases, and it is in moderate cases that it is most problematic to explain to parents what to expect.

The study partly clarifies this uncertainty by allowing doctors to better understand what is happening with their little patient, she explained.

“Three or five days may seem short, but it’s a very long time for parents,” said Dr. Pinchefsky. “We will be able to give them more information, and that will be very useful in guiding discussions with families.”

The goal, she added, is to optimize how these monitoring data are used to better assess these babies, “but also to provide better prognostic information to parents at the bedside throughout this process.”

“Now, we need to understand how to present these data and how to use them at the bedside,” she added.

The goal of the study, said Professor Dehaes, was to better understand the interactions between electrical activity measured with the electroencephalogram and vascular and metabolic activity measured by neuromonitoring.

All of this fits into the broader framework of precision medicine, Professor Dehaes continued, since these data could, for example, help determine whether a baby needs longer or shorter therapeutic hypothermia to achieve an optimal prognosis.

“In my opinion, this is one of the most important impacts of the study,” he assured. This will likely allow us to better understand the trajectories of these children, and then, precisely, whether they need additional care or not, thus truly optimizing their clinical trajectory.”

The work was carried out by former postdoctoral fellow Rasheda Arman Chowdhury and by doctors Anne Monique Nuyt, Ramy El-Jalbout, and Ala Barca, who died prematurely during the course of this research project. The findings were published in the journal Scientific Reports.

–This report by La Presse Canadienne was translated by CityNews