In 2007, Arkansas Children's Hospital (ACH) in Little Rock was the first hospital in the world to use the Olympic Medical Cool-Cap on an infant within hours of its FDA approval. Today, ACH provides whole body cooling as part of a multidisciplinary neonatal neurocritical care program between the neonatology intensive care unit (NICU) and neurology, providing high-level, specialized care to neonate patients. Program medical experts treat several conditions, including:
Therapeutic hypothermia is the clinical treatment of intentionally lowering the infant’s body temperature in a controlled manner for a specific time period in order to reduce damage to the brain after injury.
"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."
The program also offers fetal MRIs and neonatal neurology prenatal consultations for neurologic disorders diagnosed prenatally.
“Looking to the future, we’re exploring ways to expand that ability to provide advanced neuroimaging, potentially even in units, which would be a really incredible part of the program,” Dr. Ross said.
The collaborative effort between neonatology, neurology and other subspecialists led to neurology pathways for therapeutic hypothermia for HIE, neuroimaging protocols and neonatal seizure management. Families can also participate in neonatal neurology research protocols led by pediatric neurology and neonatology.
"We are the only comprehensive therapeutic hypothermia program in the state that offers continuous VEEG monitoring read by in-house pediatric epileptologist, neonatal neurologist consultation, neonatal specific MRI capabilities and pediatric neuroradiology," said Sarah Cobb, 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."
The use of cooling technology has impacted outcomes for neonates.
"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, the better the chance of an outcome," Dr. Ross said. The technology is placed within six hours after a baby's birth and cools them for 72 hours.
Virginia Erin Willis, M.D., pediatric neurologist at ACH, chief of neurology and associate professor of pediatrics at UAMS, said they’ve also seen success in improving the outcomes of pediatric patients with stroke and traumatic brain injuries (TBI).
"We can give TPA (tissue plasminogen activator) 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 rehab teams to ensure these patients have a plan to get them back to school and functioning the best way they can."
Dr. Willis said the program’s success allows for continued expansion.
"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 Dr. Adrianne Parkey move into the PICU," Dr. Willis said. "We're recruiting for a stroke neurologist that we hope to eventually have to 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."
The program’s life-saving work is a benchmark for collaborative work within the NICU and other subspecialists, enhancing care and improving the lives of patients and their families.