Advanced imaging confirms cooling therapy targets brain’s core in newborns

When a newborn suffers from a lack of oxygen there are few clinical options besides whole-body cooling to save important brain tissue. But until now, it’s been difficult to determine how receptive the organ has been to such temperature changes.

This new development—utilizing advanced imaging—is able to accurately and noninvasively record temperature in the deepest parts of a patient’s brain. And in the study, published Feb. 20 in the Journal of Pediatrics, researchers used this novel technique to confirm controlled cooling does in fact reach the brain’s core.

“We thought that the core of the brain would be warmer than the outer portions,” Tai-Wei Wu, MD, a neonatologist at Children’s Hospital in Los Angeles said in a statement. “This is usually how body temperature works.” However, he went on to note, in every patient the center of the organ was actually the coldest—“so the effect is real,” he said later.

More than 50 infants with hypoxic-ischemic encephalopathy were enrolled in this prospective, observational study. Wu et al. used MR spectroscopy more than 200 times to measure and correlate temperature with the depth of the patient’s brain structure.

In addition to now knowing that the therapeutic approach is indeed reaching the site most likely to be injured, the team detected small changes in temperature across brain regions. In some cases, these differences were as small as 0.2 degrees Celsius.

Understanding how whole-body cooling affects different brain regions could prove invaluable, and may allow clinicians to customize treatment to individual infants, the authors noted.

“The fact the brain isn’t homogeneously cooled is important information to have,” Wu said. “The outer portion of the brain is hit harder in about 20% of hypoxic patients. So, this study shows us how we could better serve individual babies,” he added. “And better outcomes really are our goal.”