Successful Infant Cooling Program Launched in India to Treat Moderate Hypoxic Brain Injury in Newborns

It’s all about “Cooling the Kids.”

Connecticut Children’s Medical Center neonatologists Naveed Hussain, MD, and Leonard Eisenfeld, MD, have made it their mission to help launch an Infant Cooling Program in Hyderabad, India, for infants with moderate hypoxic brain injury.

Dr. Hussain and Dr. Eisenfeld, along with several colleagues from UConn Health Center, traveled halfway around the world in October 2015 to implement the program at the non-profit Neonatal Intensive Care & Emergencies (NICE) Institute for the Newborn in Hyderabad, a city of 8.7 million people.

According to Dr. Hussain, lack of oxygen to the brain in newborns – or birth asphyxia – is a leading cause of infant mortality in India, where neonatal mortality accounts for 65 percent of infant deaths. In babies who survive resuscitation at birth, brain injury manifests as Hypoxic Ischemic Encephalopathy or HIE.

“Infants with mild HIE recover without much medical intervention, and those with severe HIE have a high mortality and morbidity despite medical treatment,” said Dr. Hussain, who has been part of Connecticut Children’s global health presence in India since 2008. “However, those with moderate – or Stage II – HIE can be treated by total body cooling, the only effective therapy for HIE.”

“We started a neonatal cooling program here at Connecticut Children’s in 2007,” Dr. Hussain noted. “The results have been good.”

Neonatal Therapeutic Hypothermia

Neonatal therapeutic hypothermia – or cooling – is a relatively new treatment option in which an infant’s total body temperature is decreased shortly after birth in order to reduce the chances of severe brain damage and slow the progression of disease.

Apoptosis – or programmed cell death – can begin with a lack of oxygen to the brain. “Immediately, the baby’s brain begins to die,” Dr. Eisenfeld explained. “You can prevent some of that from happening by lowering the baby’s core body temperature, about five degrees lower.

“We cool these babies for three days,” Dr. Eisenfeld said. “You have to start within the first six hours after birth.”

Project Rollout

The goals of the Infant Cooling Program for Hyderabad, India, were to train local staff and area professionals on the uses, protocols and procedures of Infant Cooling and provide them with the specialized equipment needed to perform the procedure.

Organized under Connecticut Children’s Center for Global Health, the mission began in July 2015 with an appeal to raise money for the necessary equipment and supplies. Donors to Connecticut Children’s Medical Center Foundation quickly responded and helped raise the $11,000 needed for the cooling equipment and an additional $4000 to run the program for two years.

Outfitted with blue “Cool the Kids” T-shirts designed by Dr. Eisenfeld’s daughter, Amy, and with input from his wife, Vicki, the two Connecticut Children’s neonatologists and members of the UConn Health Center staff met up with the rest of the team to conduct the Hypothermia Workshop at the NICE Institute Oct. 16-19.

“Over the past six months – from November 2015 through May 2016 – we have shown good outcomes in 12 infants,” Dr. Hussain said. “All of these babies are doing fine. We are now preparing to expand the program both in its capacity and in the area covered in the villages surrounding the city of Hyderabad,” he said.

Looking Ahead

Dr. Hussain said they are now seeking funds to expand the reach and capacity of the Infant Cooling Program at the NICE Institute.

Funds raised will be used for purchase of educational material and resuscitation and support kits to be used in 100 villages. The kits will be made available for ongoing use in each covered village but the educational material will be re-used for other teaching and education programs in the future.

If you would like to help support the Infant Cooling Program, contributions can be made online via the Connecticut Children’s Foundation website.