Isabella Blackard’s life began traumatically.

When doctors removed her from her mother via cesarean section on Jan. 22, she was unresponsive and not breathing.

Her mother, Cristin Blackard, had realized something was wrong when her water broke and it contained blood. She rushed to the emergency room in Klamath Falls where they found no heartbeat for the baby. Blackard was quickly in surgery.

Once the baby was born, nurses and doctors immediately started trying to resuscitate the little girl, according to medical records later provided to St. Charles Bend.

At one minute, the baby wasn’t responding.

At five minutes, she was still not breathing but had a faint pulse.

At seven minutes, Isabella began breathing.

If they had reached nine minutes without a response, Blackard said she later learned, they would have declared the baby dead.

The team at Sky Lakes Medical Center in Klamath Falls “really saved her life,” said Dr. John Evered, a neonatologist at St. Charles Bend who treated baby Isabella.

But even once babies like Isabella are clear of the immediate trauma, there are lots of things that can go wrong.

The most serious is brain damage. No one knows how long Isabella went without oxygen before she was born.

Sometimes babies deprived of oxygen at birth are so brain damaged they have little chance of a normal life. They are always at higher risk of developmental disorders such as cerebral palsy, visual or hearing impairments and behavioral problems. More than half die after the trauma.

Until recently, there was fairly little doctors could do for them. Now, there’s one therapy that’s proven to help these babies: induced hypothermia.

Cooling the body

Studies show that lack of oxygen happens in about one of every 1,000 births.

The lack of oxygen itself, depriving brain cells of the fuel they need to live, can kill those cells, said Evered. That itself can cause brain damage.

But, surprisingly, Evered said, much of the brain damage can occur after the initial trauma, once blood and oxygen are again flowing freely. Then, the body tries to repair the injury, and in doing so, sends chemicals that cause inflammation.

While the inflammation response is in some cases beneficial, in this case it can do more harm. The response, Evered said, includes “a species of oxygen that can be toxic to the brain.” In trying to repair itself, the baby’s brain response can actually cause more damage.

But just as icing a knee or ankle injury hinders inflammation, cooling a baby’s body can slow that harmful inflammatory response. “It decreases the ability of some inflammatory chemicals to do their jobs effectively,” Evered said, “or create problems effectively.”

At St. Charles, the cooling technique, which induces hypothermia in a newborn, is used about half a dozen times a year.

Babies who need cooling are placed on a special blanket with tubes inside. Water from a nearby unit runs through those tubes. The baby’s temperature is monitored and kept at about 92 degrees using cooler or warmer water.

In the first studies of this technique, released about five years ago, the results were promising. Babies cooled for 72 hours either died or became severely disabled 44 percent of the time. Without cooling, these dire outcomes occurred 62 percent of the time.

Other studies confirmed the benefit. Indeed, it’s the only thing that’s been shown to help these babies.

“It’s not a silver bullet,” said Dr. Sandra Juul, a neonatologist at Seattle Children’s Hospital who studies how to help babies with brain damage. “But we’ve shown that you can actually change outcomes and that’s huge.”

Sick baby

Blackard said that when she woke up from the C-section, medical staff in Klamath Falls told her the baby was very sick and needed to be taken to a larger hospital. A team from AirLink, St. Charles Health System’s air ambulance service, arrived within two hours of Isabella’s birth.

The baby was not doing well. She had several seizures, “a mark of pretty severe shock or injury to the brain,” said Evered. She was put on a ventilator to help her breathe.

Typically, babies are warmed when they are first born. Newborns, and particularly those born prematurely, are not good at controlling their own body temperature. Indeed, hypothermia is one of the ways that premature infants can and do die.

But the cooling procedure is done under strict monitoring, and only in infants born at or near full-term, to avoid the risks of hypothermia. In addition, the baby’s temperature is kept very close to 92 degrees, and not allowed to start the free fall that can severely injure or kill a baby.

In studies of the cooling procedure there were few adverse events associated with it.

“When people started, there was a lot of anxiety,” said Juul, but “it’s actually proven to be very, very safe.”

The AirLink team knew Isabella needed the cooling procedure. They turned off the warming blankets they would typically use when transporting a newborn.

They spent a few hours stabilizing the baby in Klamath Falls, Blackard said, and flew her back to Bend.

About six hours after the AirLink team arrived in Klamath Falls, Isabella was admitted to St. Charles. It was 2 a.m.

She was immediately put in a cooling blanket. She stayed there for the next 72 hours.

Meanwhile, her family began gathering in Bend. Blackard’s husband, Jesse Blackard, had not made it to Klamath Falls because he had been at their home in Bandon, a town on the coast, packing to fly out the next day for job training.

He deferred the training and went straight to Bend. When he got to the hospital, the baby was already on the cooling blanket.

“She was pretty horrible looking,” he said. She had a purple tinge, and her feet were dark purple. “I was tripping out.”

Isabella did fine during the three days while she was cooling. Then, the medical staff warmed her back to a normal body temperature, one degree at a time. That’s when things went downhill.

“It seemed like she was showing all the wrong signs,” said Jesse. Isabella didn’t respond to touch, her reflexes weren’t working well, and she wasn’t breathing normally.

She showed signs of pulmonary hypertension, said Evered, a sign that her lungs weren’t working properly. “She was pretty sick.”

The staff in the neonatal intensive care unit began talking to the Blackards about whether they wanted her to be kept alive in case she took another turn for the worse.

Jesse Blackard said it changed his perspective. He used to see people taking care of loved ones in dire shape and wonder how they lived with that quality of life. With Isabella, he said, he found himself just wanting her to live no matter what.

“You don’t question it,” he said. “Let her grunt, and I’ll wipe her face until she’s 50.”

Normal newborn

But slowly, slowly, Isabella started to get better.

The first good sign was when she gripped her mother’s finger. Then she reacted to her feet being tickled. Soon, they watched as Isabella tried to put her fingers in her mouth.

About two weeks after Isabella was admitted into the hospital, an X-ray scan of her brain came back normal.

“It’s a very good sign,” said Evered. It does not mean that Isabella will not have problems, but it does point toward good outcomes.

The Blackards expect later issues, Jesse said, and doctors have told them she may be later to hit the major milestones. “No matter how well she’s doing, she went through a lot,” he said. “She’s still a trauma baby.”

The family went home about three weeks after Isabella’s birth. On the day before they left the hospital, Isabella spent her day the way most newborns do, eating and sleeping.

“She’s a good eater,” said Isabella’s mother as she lifted her to breastfeed for the third time in an hour. “She’s done so much better than any of us ever hoped or dreamed.”

How cooling helps brain injuries

1: When the brain is injured by some trauma, including a lack of oxygen, the body sends chemicals to the brain that cause it to swell. These inflammatory chemicals can further damage the brain.

2: Just as icing a swollen knee or ankle would prevent some swelling, cooling a baby’s brain hinders the swelling response. Doctors try to begin the cooling process within six hours of the initial injury to minimize further damage.

3: Babies are typically cooled for 72 hours, which has proven to be enough time to hinder the inflammation that can cause permanent brain damage.

Sources: Dr. John Evered; Dr. Sandra Juul