A birth injury can be an overwhelming experience for a family, particularly when a newborn has experienced a serious lack of oxygen or blood flow to the brain. One treatment that can improve outcomes for some affected newborns is therapeutic hypothermia, also known as neonatal cooling therapy.

Therapeutic hypothermia is an evidence-based treatment for carefully selected newborns who develop moderate-to-severe hypoxic-ischemic encephalopathy (HIE). HIE occurs when the brain does not receive enough oxygen and/or blood flow, potentially resulting in brain injury.

Importantly, not every newborn who experiences oxygen deprivation is a candidate for cooling therapy. Eligibility depends on factors such as gestational age, evidence of a significant hypoxic-ischemic event, and the infant’s neurological condition.

What Is Therapeutic Hypothermia?

Therapeutic hypothermia is a specialized treatment that carefully lowers a newborn’s body temperature for a limited period of time. The goal is to slow some of the processes that can contribute to ongoing brain injury after an initial lack of oxygen and blood flow.

According to the American Academy of Pediatrics (AAP), therapeutic hypothermia to a target temperature of approximately 33.5°C to 34.5°C (92.3°F to 94.1°F), when started within 6 hours of birth and continued for 72 hours, reduces the risk of death or moderate-to-severe neurodevelopmental impairment in eligible newborns born at or beyond 36 weeks’ gestation with moderate-to-severe HIE.

Cooling is not simply a matter of placing a baby in a cold environment. It is a carefully controlled medical treatment performed in a neonatal intensive care setting, with continuous monitoring and specialized neurological care.

How Does Cooling Therapy Help the Brain?

When the brain is deprived of oxygen and blood flow, a complex series of biological processes can cause injury. Some brain cells may be damaged immediately, while additional injury can occur during the hours that follow.
Lowering the newborn’s core body temperature in a controlled manner can slow the brain’s metabolic activity and reduce some of these secondary injury processes.

Research from multiple randomized controlled trials has demonstrated that therapeutic hypothermia can improve outcomes for appropriately selected newborns with moderate-to-severe HIE. The treatment is now considered standard care for eligible infants in many neonatal intensive care units.

The American Heart Association’s neonatal resuscitation guidelines similarly describe therapeutic hypothermia as a treatment that may improve outcomes for selected newborns with neurological injury.

When Should Cooling Therapy Begin?

Timing is critical.

For an eligible newborn, therapeutic hypothermia should generally be started within 6 hours of birth. The treatment is then continued for approximately 72 hours, followed by carefully controlled rewarming.

Because the potential benefits of treatment are time-sensitive, a newborn who may have HIE should be evaluated promptly by a medical team with experience in neonatal neurological care.

This is one reason hospitals may rapidly transfer an affected newborn to a neonatal intensive care unit (NICU) or a center equipped to provide therapeutic hypothermia.

Which Newborns May Receive Cooling Therapy?

Therapeutic hypothermia is not appropriate for every newborn who has experienced oxygen deprivation.

The AAP’s 2026 clinical report recommends therapeutic hypothermia for appropriately selected newborns who:

• Are at least 36 weeks’ gestation;
• Have evidence suggesting a significant hypoxic-ischemic event; and
• Have moderate-to-severe HIE based on neurological examination and other clinical findings.

For newborns born at 35 weeks to 35 weeks and 6 days, cooling may be considered in some circumstances after clinicians weigh the potential benefits and risks.

For infants born before 35 weeks’ gestation, current evidence does not support routine therapeutic hypothermia.

The exact criteria used to determine eligibility can vary somewhat based on clinical circumstances and institutional protocols. Doctors may consider blood-gas results, the need for resuscitation, Apgar scores, neurological examination findings, seizures, and other evidence of a significant hypoxic-ischemic event.

A low Apgar score alone does not establish that a newborn has experienced an oxygen-deprivation injury or determine whether cooling therapy is appropriate. The American College of Obstetricians and Gynecologists (ACOG) notes that Apgar scores must be considered alongside other clinical information.

What Happens During Cooling Therapy?

When therapeutic hypothermia is indicated, the newborn’s temperature is carefully reduced to the target range of approximately 33.5°C to 34.5°C.

The infant is continuously monitored throughout treatment. Depending on the baby’s condition, monitoring may include:

• Heart rate and breathing
• Blood pressure and oxygen levels
• Blood glucose and electrolytes
• Seizure activity and brain function
• Blood gases and other laboratory measurements
• Neurological status
• Brain imaging, including MRI when appropriate

The AAP emphasizes that therapeutic hypothermia should be accompanied by appropriate neuromonitoring, neuroimaging, and follow-up of neurodevelopmental outcomes.

After approximately 72 hours of cooling, the infant is gradually rewarmed under close medical supervision.

Is Therapeutic Hypothermia Safe?

Therapeutic hypothermia has been studied extensively and is considered an important treatment for eligible newborns with moderate-to-severe HIE. However, it is not risk-free.

Potential complications can include changes in heart rate, blood pressure, blood clotting, glucose levels, electrolyte levels, and other physiological functions. These risks are one reason cooling must be performed under careful medical supervision.

The potential benefits and risks should be evaluated for each newborn based on gestational age, severity of HIE, overall medical condition, and other factors.

Does Cooling Therapy Prevent Cerebral Palsy?

Therapeutic hypothermia does not guarantee that a child will avoid cerebral palsy or other neurological disabilities.

However, research has demonstrated that cooling therapy reduces the combined risk of death or moderate-to-severe neurodevelopmental impairment among appropriately selected newborns with moderate-to-severe HIE.

HIE can result in a range of neurological outcomes. Some children who experience HIE may later develop cerebral palsy, epilepsy, developmental delays, cognitive difficulties, or other neurological conditions, while others may have fewer or no significant long-term impairments.

Early identification and treatment of HIE, followed by appropriate developmental monitoring and intervention, are important parts of caring for these children.

Why Early Follow-Up Matters

Even when a newborn receives therapeutic hypothermia, ongoing developmental follow-up is important.

The AAP recommends neurodevelopmental follow-up for infants who have experienced significant HIE. Pediatricians and specialists may monitor motor development, communication, cognition, vision, hearing, feeding, behavior, and other areas as the child grows.

Early intervention can be especially valuable when developmental concerns are identified. Physical therapy, occupational therapy, speech and language therapy, and other services may help children develop skills and participate as fully as possible in everyday life.

What Should Parents Know?

If your newborn experienced oxygen deprivation, was diagnosed with HIE, or received therapeutic hypothermia, it is understandable to have questions about what the future may hold.

The most important thing to know is that cooling therapy is a time-sensitive treatment for specific newborns—not a treatment for every case of oxygen deprivation.

If your baby may be experiencing HIE, the neonatal medical team should evaluate the infant as quickly as possible to determine whether therapeutic hypothermia is appropriate.

Parents can also ask the medical team:

• Was my baby diagnosed with HIE?
• How severe is the encephalopathy?
• Does my baby meet the criteria for therapeutic hypothermia?
• When did cooling begin?
• How long will cooling continue?
• What neurological monitoring and imaging will be performed?
• What follow-up care will my baby need after leaving the hospital?

Therapeutic hypothermia has become an important advance in the care of newborns with moderate-to-severe HIE. When used for the right patients and started within the appropriate treatment window, it can reduce the risk of death and serious neurodevelopmental impairment.

Could Medical Negligence Have Played a Role?

When your child is at risk of brain damage, it’s important that doctors respond quickly and appropriately. If you suspect that your child has suffered as the result of medical error, contact the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs to discuss your potential case. We know that you’re experiencing an overwhelming amount of emotional trauma, and we want to help make the road to recovery as simple as possible. We’re here by your side to offer the educational and legal resources you need to help improve your child’s quality of life.

Important Note

This article is intended for educational purposes only and should not replace medical advice. Therapeutic hypothermia is a specialized treatment that must be evaluated and administered by qualified neonatal medical professionals. If you have concerns about a newborn’s condition, seek immediate medical attention.

 

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