When Aileen Kindsfater went into labor with her and her husband’s fourth child in early April, she had no idea her situation was about to become critical. Her baby boy had a normal heart rate, but he wasn’t moving or responding as much as he should’ve been. Her care team at St. Vincent knew they had to get him delivered quickly and they didn’t think he would tolerate a vaginal delivery, so Aileen was prepped for a cesarean section.
“He needed 40 seconds of resuscitation when he was born in order to revive him. That doesn’t sound like a long length of time, but it felt like eternity to me,” recalled Aileen. “Once he was born, they discovered that he had an abnormal umbilical cord. We’re not sure how long he was oxygen deprived prior to being born, but it was likely for a few days.”
Baby Silas was diagnosed with a moderate case of hypoxic ischemic encephalopathy (HIE). Physicians decided he was a prime candidate for a new treatment offered at St. Vincent called neonatal therapeutic hypothermia, which deliberately reduces the baby’s core body temperature in order to reduce the chances of severe brain damage.
“They found that if you cool the whole body and decrease the metabolic rate so they don’t need as much energy to function, the baby’s brain heals better and the injury isn’t as severe for the long term,” Alison Rentz, MD, St. Vincent Neonatalogist, explained.
During the treatment, the baby is placed on a blanket with water running through it that cools the body temperature to 33.5 degrees Celsius (92.4 degrees Fahrenheit).
Infants diagnosed with HIE fall into three categories: mild, moderate or severe.
“Patients with moderate HIE benefit the most,” Dr. Rentz said. “It helps severe patients some, but they still have a high chance of long-term neurologic problems.”
Many large studies have shown induced hypothermia with whole body cooling reduces the incidence of death and disability in full term infants with HIE.
“Silas was cooled for 72 hours and then was slowly warmed over the course of six hours,” explained Aileen.
Hypothermia must be initiated before six hours of life and the earlier hypothermia is initiated, the better the neurological outcome. Prior to October 2017, a baby in Silas’ condition would’ve been transported to an out-of-state hospital.
St. Vincent offers the new service in partnership with Intermountain Primary Children’s/University of Utah in Salt Lake City. St. Vincent neonatologists collaborate with neonatal neurologists from Primary Children’s through the entire cooling process and the neonatal neurologist provides consults to the family. This is an essential part of the program and through the affiliation, St. Vincent is able to offer this complete service to NICU patients and families.
A few days after Silas’ therapeutic hypothermia, he underwent a MRI, which was reviewed by the neonatal neurologist at Primary Children’s.
“Silas’ scan came back completely normal,” Aileen said. “It was scary to have to wait to find out if he had neurological damage, but we are so relieved and thankful. We received the best news we could have hoped for.”
The treatment has given Silas a 85 percent chance of normal development. Prior to therapy, his chance of a long-term normal outlook was below 50 percent, according to Dr. Rentz.
“We know this was a true miracle – we didn’t know we’d be needing this new service at St. Vincent, but we’re so glad it was here and that we didn’t have to travel away from home,” Aileen said. “We’re breathing a big sigh of relief. God really brought Silas through this trauma.”
Photos courtesy of Mike Kindsfater.