Neonatal Hypoxic Ischemic Encephalopathy

Brain Cooling

Immediate treatment for infants born with HIE involves cooling the baby for three days. Research has shown that if the brain is cooled just a few degrees below normal body temperature soon after birth, there may be less brain injury.

Your baby will be placed on a cooling blanket for three days. Babies are then given medicines to help them rest comfortably and are closely monitored for any signs of discomfort.

After the cooling period, your baby will be slowly re-warmed to normal body temperature. UCSF's Neuro-Intensive Care Nursery is equipped to provide this cooling treatment to even the very sickest babies who require ECMO, a type of bypass used to support infants with respiratory failure.

While caring for your baby, we will monitor his or her heart rate, breathing patterns and temperature. During the cooling procedure, we will also check your baby's brain activity with an electroencephalogram (EEG) and a cerebral function monitor (CFM). Small probes are placed on the scalp to measure the electrical activity of the brain. In addition, we will look for signs of seizures using a video camera.

Blood tests will also be sent to evaluate other aspects of your baby's health such as infections or metabolic problems.

During the cooling period, it is normal for your baby to have a slower heart rate and breathing rate, and to appear quiet and sleepy. Your baby will receive nutrition through intravenous (IV) therapy. If the nurse determines that it is safe, you may touch your baby (and may even be able to hold him or her) during the cooling period.

After cooling, and when your baby is ready to eat, breast milk or formula will be given. Breast-feeding mothers will receive accommodations and assistance with pumping and storing milk.

At the end of the cooling period, you will meet with the medical team to review the results of tests, including the MRI.

Other Therapies

In addition to cooling, your baby may receive a combination of therapies to support any other organs that have been affected by HIE. This may include:

  • Supporting the heart and maintaining healthy blood pressure
  • Sustaining kidney and liver function
  • Mechanical ventilation (breathing tube) if the baby is unable to breathe independently
  • Medications for babies who have seizures

After HIE, treatment focuses on helping your child adapt to symptoms caused by the brain injury. This often includes a combination of approaches, including medical, physical and occupational therapies. All babies who receive cooling therapy are eligible for follow-up in the High Risk Infant Program and the Neonatal Neurology Follow-Up Program.


Some families are eligible for research studies that may involve long-term follow up, specialized tests and new treatments. A member of the research team may ask if you are interested in participating.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers

Neuro-Intensive Care Nursery (NICN)
1975 Fourth St., Third Floor
San Francisco, CA 94158
Phone: (415) 353-1565
Fax: (415) 353-1202

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