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Headlines 15 T wo decades ago, a group of Kiwi physicians and scientists at the University of Auckland developed a world-first device for reducing brain damage in babies. The head-cooling cap, or CoolCap, alleviates the severe effects of oxygen deprivation at birth. It works by circulating cold water around a baby’s head. By suppressing evolving brain injury, it has saved the lives of countless babies and prevented life-long disability. While it has been extremely successful (it has improved the chance of surviving without disability by over 50%), the device is not infallible. Some babies will only receive partial benefits from the intervention, and around 20-40% still survive with neurodevelopmental problems. Finding ways to refine the treatment could have a significant impact on those babies it fails to protect. In the last five years, three researchers in the Department of Physiology at the University of Auckland have received Neurological Foundation grants for individual projects looking at extending the benefits of the CoolCap device. Each researcher is at different stages of their careers, and is approaching the intervention from different angles. Among them is Professor Alistair Gunn, who led the team that developed the device. He has been looking at ‘rewarming’ of the brain after cooling, a critical phase for optimal brain recovery. Completing his study in 2020, he found the rate of rewarming, whether rapid or gradual, made little difference. However the duration of cooling is critical – information that is helping clinicians make informed decisions when using the CoolCap. Alistair’s colleague, Associate Professor Joanne Davidson, worked on the rewarming study and has just started her own three-year Neurological Foundation-funded study. It looks at the added complication of brain inflammation and oxygen deprivation at birth, which affects some, but not all, babies. “There has been considerable speculation in the field that cooling is less effective for infants with brain inflammation and oxygen deprivation, but there is limited evidence to support this claim,” Joanne says. “We want to test this, and to look at whether the addition of an anti-inflammatory drug, Anakinra, may better prevent brain damage.” Part of Joanne’s role is to supervise PhD students, among them Alice McDouall, who joined the lab as a research technician in 2019. “I was inspired by the real-life impact of the group, and the potential to be involved in work with direct implications on the clinical management of sick babies,” Alice says. She designed a doctorate project tomake her own contribution to protecting vulnerable newborns, looking at mild oxygen deprivation at birth – an under-researched area. The CoolCap is not used in babies withmild oxygen deprivation. “Historically, it was thought mild oxygen deprivation didn’t cause neurological damage, but there’s an emerging realisation that some of these babies may go on to develop significant brain damage and disability,” Alice says. Her study, completed this year, looked at the safety and efficacy of an anti-inflammatory drug to treat these babies. Alice says her results look promising, and she is preparing them for publication. The three researchers have received around $577k in total from the Neurological Foundation towards improving the CoolCap intervention. Alice’s work is generously supported by Peter and Wendy Gillespie. The CoolCap has saved thousands of babies from death and disability. Researchers from the Department of Physiology at the University of Auckland say despite its remarkable success, there is room for improvement. “I was inspired by the real-life impact of the group, and the potential to be involved in work with direct implications on the clinical management of sick babies.” Alice McDouall Hypothermia increases cell survival. Untreated brain left, with cooled brain on the right.