title: Significant head cooling can be achieved while maintaining normothermia in the newborn piglet.
abstract: BACKGROUND
  Hypothermia has been shown to be neuroprotective in animal models of hypoxia-ischaemia. It is currently being evaluated as a potentially therapeutic option in the management of neonatal hypoxic-ischaemic encephalopathy. However, significant hypothermia has adverse systemic effects. It has also recently been found that the stress of being cold can abolish the neuroprotective effects of hypothermia. It is hypothesised that selective head cooling (SHC) while maintaining normal core temperature would enable local hypothermic neuroprotection while limiting the stress and side effects of hypothermia.
  
  
  OBJECTIVE
  To determine whether it is possible to induce moderate cerebral hypothermia in the deep brain of the piglet while maintaining the body at normothermia (39 degrees C).
  
  
  METHODS
  Six piglets (<48 hours old) were anaesthetised, and temperature probes inserted into the brain. Temperature was measured at different depths from the brain surface (21 mm (T(deep brain)) to 7 mm (T(superficial brain))). After a 45 minute global hypoxic-ischaemic insult, each piglet was head cooled for seven hours using a cap circulated with cold water (median 8.9 degrees C (interquartile range 7.5-14)) wrapped around the head. Radiant overhead heating was used to warm the body during cooling.
  
  
  RESULTS
  During SHC it was possible to cool the brain while maintaining a normal core temperature. The mean (SD) T(deep brain) during the seven hour cooling period was 31.1 (4.9) degrees C while T(rectal) remained stable at 38.8 (0.4) degrees C. The mean T(rectal)-T(deep brain) difference throughout the cooling period was 9.8 (6.1) degrees C. The mean T(skin) required was 40.8 (1.1) degrees C. There was no evidence of skin damage secondary to these skin temperatures. During cooling only one piglet shivered.
  
  
  CONCLUSIONS
  It is possible to maintain systemic normothermia in piglets while significantly cooling the deeper structures of the brain. This method of cooling may further limit the side effects associated with systemic hypothermia and be feasible for premature infants.
authors.affiliation: Department of Child Health, St Michael's Hospital, Southwell Street, Bristol BS2 8EG, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Tooley
authors.forename: R C
authors.initials: RC
authors.lastname: Eagle
authors.forename: S
authors.initials: S
authors.lastname: Satas
authors.forename: M
authors.initials: M
authors.lastname: Thoresen
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001794:Blood Pressure; D001831:Body Temperature; D001921:Brain / Q000473:pathology; D004195:Disease Models, Animal; D004569:Electroencephalography; D005240:Feasibility Studies; D006257:Head; D006339:Heart Rate; D006863:Hydrogen-Ion Concentration; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000517:prevention & control*; D013552:Swine; D013696:Temperature