In the labor room of TU Teaching Hospital, a mother with no pre-natal (before pregnancy) complications or health issues delivered her first child via normal vaginal birth. Immediately after delivery, however, the baby did not cry, prompting the staff to initiate urgent measures. A quick assessment revealed no detectable heart rate. The team began bag‐and‐mask ventilation (using a bag and mask to assist breathing), but the infant remained unresponsive.
The pediatrician on duty was called and arrived without delay. Upon evaluating the baby, he confirmed that the heart rate was absent, initiated CPR (cardiopulmonary resuscitation), and intubated the child (inserted a breathing tube into the airway so that artificial breath can be provided when the child doesn’t breathe by himself). CPR continued for 5 minutes. The team—including the pediatrician, obstetricians, and nursing staff—provided chest compressions, administered injections of adrenaline (a medication used to stimulate the heart), and continued with both bag‐and‐tube ventilation. Finally, a faint but steady heart rate returned, and the baby was transferred to the Neonatal Intensive Care Unit (NICU).
Upon arrival in the NICU, the newborn showed no spontaneous movements, no suck or grasp reflexes, and no other neurological responses. A blood gas test indicated severe metabolic acidosis (an excessive level of acid in the blood due to metabolic dysfunction). The baby’s parents, who had limited financial resources, were understandably distressed but determined to do whatever they could. Recognizing their situation, the hospital staff arranged supplemental funding provided by the Indra Jwahar Foundation for essential medications and equipment. The parents were counseled about the potential for adverse outcomes for the child.
Given the suspicion of hypoxic-ischemic injury (damage caused by a lack of oxygen and blood flow), the pediatric team decided to initiate therapeutic hypothermia—a procedure in which the infant’s core temperature is lowered to around 33–34°C. This helps reduce metabolic demands and mitigate further brain injury caused by reactive oxygen species (harmful byproducts of metabolism) that can form after a significant lack of oxygen. In settings where advanced, servo-controlled cooling equipment is unavailable, the hospital used a MiraCradle, which employs phase-change material to maintain a consistent low temperature.
After the initiation of cooling therapy, the baby experienced significant complications, including shock (a life-threatening condition in which blood circulation is inadequate) that required multiple inotropes (medications that strengthen heart contractions) for cardiovascular support. Additionally, the child developed a pneumothorax (a collapsed lung due to air in the chest cavity), necessitating the placement of a small chest tube (a tube inserted into the chest to remove trapped air). The nursing staff closely monitored the temperature and vital signs to ensure stability.
After approximately twelve hours of cooling, there was only minimal improvement. However, by the second day, the baby showed a slight return of grasp and suck reflexes. The shock began to resolve, and the pneumothorax improved, allowing the clinical team to consider removing the chest tube. On the third day, there was a notable increase in spontaneous movements and overall improvement in the baby’s condition. After 72 hours of maintaining the child at 33–34°C, the team began a gradual rewarming process.
By the end of the third day, the baby’s condition had stabilized. Feeding was gradually initiated; the child first fed via an orogastric (OG) tube (a tube inserted through the mouth into the stomach to feed a child who can’t eat by himself) and eventually began to suckle at the mother’s breast. Once the child was stable, plans were made to transfer him to a step-down unit. The mother was able to initiate breastfeeding, and the infant’s neurological status continued to improve. After the child was moved from the NICU to the general neonatal ward and monitored for a few days, both the mother and child were discharged. The parents were overjoyed to take their child home—this was the same baby who had been counseled that he might not survive or could suffer some form of neurological disability, yet he was discharged as a healthy, happy infant.
This case highlights the crucial role of therapeutic hypothermia in a resource-limited setting. By carefully lowering the infant’s body temperature and providing vigilant supportive care, the medical team gave the child a chance at a healthier future despite a severe initial presentation. It is one of those treatments where extreme measures are taken to save lives.