Maltese-led team develops technique to help oxygen-starved babies

Babies deprived of oxygen during birth will be cooled to reduce subsequent brain injury in a new technique developed by an international research team led by a Maltese doctor.

The treatment, planned to be used at Mater Dei Hospital and called total body hypothermia, is the result of years of research in which Denis Azzopardi, professor of neonatal medicine at Imperial College London, was “lucky to have been involved in from the beginning”.

His work has already been put into effect across the UK. Babies’ core temperature is cooled to 33oC (from the normal 37oC) as “standard practice” for those suffering from asphyxia (oxygen deprivation) during birth.

In Malta, the hospital’s paediatrics department is looking into procuring a machine, through a public tender, that would enable it to apply the treatment.

The necessary medical protocol is being fine-tuned. “We are well aware of its benefits and potential difficulties,” said the chairman of the paediatrics department, Simon Attard Montalto.

Asphyxia can be caused when the umbilical cord is wrapped around the baby’s neck during birth. It is not rare, with five to 10 per cent of babies having a degree of lack of oxygen at birth. However, the number that would need treatment is much lower as only a few would fall into the category that risk significant neurological damage, according to Prof. Attard Montalto.

“It (hypothermia treatment) will only apply to two, maybe three babies per year,” he said, emphasising it is only a small subgroup that would qualify medically for this treatment.

By cooling them down, babies had a better chance of survival and of having fewer disabilities but it was “not magic” and did not work for everyone, the paediatrician said. “But for those where it can make a difference it is a significant difference.”

Using magnetic resonance imaging, the researchers realised that after asphyxia there was subsequent recovery of brain function, which, however, deteriorated again after some eight hours, Prof. Azzopardi said.

“It’s like when you hit your leg and the bruising and swelling continues to get worse and actually looks worse two days after the injury.”

Cooling, the team found, reduced this secondary brain injury by stopping harmful processes and allowing the organ to recover over a period of time.

Studies show that this treatment increases by 50 per cent the number of babies surviving without brain damage following birth asphyxia. It was the first effective treatment for this devastating condition and more research was now being done to discover additional new treatments, Prof. Azzopardi said.

It is accepted therapy in the UK and has been endorsed this year by Britain’s National Institute of Clinical Excellence. Some 90 babies per month in about 50 hospitals are being wrapped in sophisticated cooling blankets and benefitting from this treatment in the UK.