For twentysomethings Jace and Amber McKeever of Marshalltown, the birth of their daughter, Malia, in 2008 was a dream come true. When severe birth asphyxia threatened to steal away the couple's dream at the very moment of its fulfillment, the new parents turned to a remarkable treatment technique at Blank Children's Hospital to give their daughter her best chance at life.
One Tuesday in the summer of 2008, Amber, a registered nurse at a hospital clinic in Marshalltown, returned home after work-two days past her daughter's due date-wondering why she hadn't felt the baby move in her stomach recently. After eating, drinking a sugary drink and attempting to count her daughter's movements on the advice of an obstetrician, Amber still felt nothing; that's when she knew it was time for Jace, an export compliance specialist at Emerson Process Management, to take her to the hospital.
Amber underwent an emergency cesarean section at the hospital due to the baby's decreased movement. Malia had no spontaneous movement or breathing during her first 10 minutes of life, and blood from her umbilical cord revealed poor oxygen and blood supply to her organs. She was placed on a ventilator and transported by helicopter to the Neonatal Intensive Care Unit (NICU) at Blank Children's, where a total body cooling treatment known as therapeutic hypothermia was recommended.
"When Jace called from Blank Children's and told me about the treatment, I'd never heard of it," says Amber, who had to remain in the hospital in Marshalltown for two days while Jace stayed with Malia in Des Moines. "The staff I spoke with by phone at Blank Children's told me it would decrease Malia's brain swelling. Jace and I gave the go-ahead because the benefits seemed to outweigh the risks, and we were running out of options at that point."
Coming Out of the Cold
"Therapeutic hypothermia is a clinical treatment that involves reducing a baby's internal body temperature to approximately 91 degrees Fahrenheit for up to 72 hours in order to slow disease progression and improve health," says Samir Alabsi, MD, attending neonatologist, board-certified in perinatal-neonatal medicine, and medical director of the NICU at Blank Children's. "The technique has recently proven to be the only medical intervention for neonates with birth asphyxia that decreases brain damage and improves the infant's chance of normal survival. Therapeutic hypothermia seems to stop the cascade of events that lead to the death of brain cells due to lack of blood flow and oxygen. Neonatal therapeutic hypothermia at Blank Children's is only applied to babies who have been delivered at a minimum of 36 weeks gestation with moderate to severe birth asphyxia."
Therapeutic hypothermia must begin within six hours after a baby's birth to be effective. The treatment was initiated on Malia approximately five hours after she was born, and she was also placed on a mechanical ventilator, antibiotics, blood pressure support, anticonvulsant medications and intravenous nutrition. To cool her body, Malia was placed on a soft, plastic blanket filled with circulating, approximately 41-degree water. Similar cooling wraps were placed on her arms and trunk. As a thermometer placed inside her esophagus monitored her body temperature and a cooling system was used to control her brain temperature, Malia's body temperature was gradually lowered. After 72 hours, she was slowly re-warmed to a normal body temperature.
"Malia did great and had no complications during treatment," Amber says. "Once I was able to join Jace at Blank Children's, we spent every night in a room in the NICU. Malia improved every day, and we took her home on her two-week birthday."
Enjoying the Life of a 2-Year-Old
Today, Malia is living the full life of a normal toddler-walking, talking and going to the park with her parents. She will continue to be monitored at Blank Children's for any signs of neurodevelopmental issues due to birth asphyxia, but according to Dr. Alabsi, she is "developmentally on track."
"My wife and I can't thank Blank Children's and its exceptional staff enough," says Jace. "We're grateful therapeutic hypothermia was available at the hospital. If it hadn't been, things would certainly be different for our family."
For more information about Blank Children's, visit blankchildrens.org.