NICU, Neurology Transform Newborn Care with Neonatal Neurocritical Care Program

In 2007, Arkansas Children’s Hospital (ACH) was the first hospital in the world to use the Olympic Medical Cool-Cap on an infant within hours of its FDA approval to protect the newborn’s brain function.   

Today, ACH provides whole-body cooling in its neonatal neurocritical care program, which includes the neonatology intensive care unit (NICU) and neurology. This program provides high-level, specialized care to newborn patients.   

Therapeutic hypothermia, or whole-body cooling, is the clinical treatment of intentionally lowering an infant's body temperature at a controlled pace. The body is cooled for a specific period to reduce brain damage after an injury caused by a lack of oxygen or blood flow to the baby's brain. The technology is placed within six hours after a baby's birth and cools them for 72 hours.  

The team that leads the neurocritical care program includes neonatal nurses with specialized expertise, neonatal neurologists, pediatric neuroradiologists, pediatric neurosurgeons and neonatologists.   

ACH was part of the original medical trials that studied cooling for hypoxic-ischemic encephalopathy (HIE). This injury interrupts blood flow and oxygen to the brain when a baby is delivered. Cooling is still the only treatment for this type of brain injury. The team performed more than 150 new neurology consults in 2023, and that number is on pace to grow in 2025. In 2023, 37 infants received cooling for HIE by the neonatal neurocritical team.   

“This dedicated, very specialized team distinguishes us from other NICUs in Arkansas, along with being the only Level IV NICU in the state. This team enables us to provide comparable care alongside other top children’s hospitals nationwide,” said Ashley S. Ross, M.D., neonatologist and chief of neonatology at Arkansas Children’s and professor of pediatrics at the University of Arkansas for Medical Sciences (UAMS). “Patients referred to ACH, even after receiving treatment at other NICUs, are evaluated by the neonatal neurologist, and their neuroimaging is reviewed or performed by pediatric specialists.”   

Revolutionary Treatments

Neurocritical care program experts treat several conditions, including:   

• Brain malformations 
• Congenital neuromuscular disorders  
• Genetic and metabolic disorders  
• Intraventricular hemorrhage and other forms of intracranial hemorrhage  
• HIE  
• Hypothermia  
• Neonatal encephalopathy  
• Neonatal stroke  
• Seizures   

"We have moved from head cooling to whole-body cooling because it's much easier. It requires specialized knowledge and skill set from our nurses," Dr. Ross said. "The NICU uses the International Biomedical TecoTHERM Neo Infant Cooling System for this. Cooling is also done during transport," via Arkansas Children's Angel One Patient Transport System.   

The program also offers fetal MRIs and prenatal consultations for neurologic disorders.  

“Looking to the future, we’re exploring ways to expand that ability to provide advanced neuroimaging,” Dr. Ross said.  

Families can also participate in neonatal neurology research led by pediatric neurology and neonatology.  

“We are the only comprehensive therapeutic hypothermia program in the state that offers continuous Video Electroencephalogram (VEEG) monitoring, which helps diagnose brain disorders like epilepsy, read by an in-house pediatric epileptologist, neonatal neurologist consultation, neonatal specific MRI capabilities and pediatric neuroradiology,” said Sarah Cobb, M.D., a pediatric neurologist at ACH and assistant professor in the department of pediatrics in neurology at UAMS. “We are also one of the few sites around the country enrolling babies in a study for a novel HIE drug.”   

Saving Lives

The use of cooling technology has improved the survival rate of newborns.   

"The ability to expand cooling while being transferred to our doorsteps from the referring hospital has an impact. We know that the earlier you can cool a patient before six hours after birth, the better the chance of a positive outcome," Dr. Ross said.   

Virginia Erin Willis, M.D., pediatric neurologist and chief of neurology at Arkansas Children’s and associate professor of pediatrics at UAMS, said they’ve also seen success in improving the health of pediatric patients with stroke and traumatic brain injuries.  

"We can give tissue plasminogen activator (TPA) and do intravascular options for a pediatric stroke. When children are not moving on one side, we have a protocol; we know exactly what to do, so when they go home, they can still live a full life," Dr. Willis said. "Patients with traumatic brain injuries often have frequent seizures or brain bleeds. This team works together and knows what to do quickly. It then extends to working with the rest of the neuroscience and rehabilitation teams to ensure these patients have a plan to get them back to school and functioning the best way they can."   

Dr. Willis said that because of the program’s success, it will expand to other hospital specialties.  

“We are now extending to the pediatric intensive care unit (PICU) and hopefully eventually to the cardiovascular intensive care unit (CVICU). In addition to Dr. Cobb’s work in the NICU, another epileptologist will join the team. We’ll also have neurologist Adrianne Parkey, M.D., move into the PICU,” Dr. Willis said. “We’re recruiting for a stroke neurologist who will help in the CVICU for those little ones who have strokes. We’re very proud of our success so far through dedicated care, participating in conferences and new clinical trials.” 

This article was written by the Arkansas Children’s content team and medically reviewed by Dr. Ashley S. Ross and Dr. Virginia Erin Willis.