A Cold Bath for Baby

To the vast majority of obstetricians it has always seemed not only sound medical practice but also plain common sense to keep a newborn baby warm--especially if it has difficulty beginning to breathe. In such cases, doctors have a standard treatment: with the baby held head down, they suck fluids out of his nose, mouth, throat and bronchi, and give oxygen. If after five minutes the baby still does not breathe, they may try artificial respiration or give more oxygen. But with the baby kept warm.

To Anatomist James A. Miller Jr. this seemed like one case in which common sense was dead wrong. Since the brain's extraction of oxygen from the blood is a biochemical process, Miller figured that a cooled brain will consume less oxygen, and be in less danger of damage from oxygen deprivation, than a warmed brain. Working with his wife Faith, also an anatomist, and using guinea pigs at Atlanta's Emory University, Dr. Miller found what he considered proof of his reasoning.

That was back in 1949. and all but a few U.S. obstetricians have remained terrified of putting a baby in an icy bath. But last week the Drs. Miller, now at Tulane University, told a Manhattan meeting of the American Academy for Cerebral Palsy that in Finland, Sweden and Switzerland, 150 babies have been chilled and not killed. The few who have died after cooling almost certainly would have died without it. And among the survivors, cerebral palsy is rare or unknown, whereas among babies who have suffered the same breathing difficulty and have been kept warm, cerebral palsy is common.

Dr. Miller does not advocate chilling as a routine treatment for the newborn. Indeed, he insists that it should not be started until a baby has failed to breathe for five minutes after delivery.* Then, while efforts to start respiration continue, the child should be immersed in cold tap water, flat on his back, so that only his mouth, nose, eyes and untrimmed umbilical cord are out of the water. The baby's blood may be cooled as low as 68DEGF. If the procedure ever wins wide U.S. approval, chilling might be helpful for several thousand babies a year who would otherwise die or be doomed to live with damaged brains.

* In adults, oxygen deprivation causes irreversible brain damage within about four minutes. Nature's wisdom gives the newborn an extra ten or 15 minutes.

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