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This is the first study in Ghana on the use of hot water to massage the head of a newborn baby followed by smearing ointment on his or her head after the daily bath. The study tried to evaluate the effects of such practice on the development of the brain of a baby.

We presented here 3 baths:

One lukewarm water bath, which is an ordinary bath. In this bath the baby named Vincentia did not show any sign of stress or discomfort. Even in such bath the effect of the lukewarm water in cooling the head and the brain was visible. In the beginning of the bath, because of the warm environment of the climate and the poorly ventilated room, the temperature measured over the anterior fontanelle was 38.1 degrees Celsius. However, by the end of the bath after 12 minutes, the temperatures measured over the neck (indicating on the inner temperature of the blood flowing from the brain to the body) which was 36.6 degree Celsius, and over the anterior fontanelle which was 36.2 degrees Celsius were closed to each other. This shows the effect of the lukewarm water in cooling the head and the brain. The temperature of the brain was reduced at least by 0.5 degrees Celsius. Such a reduction in heat can be very crucial in preventing a brain damage in a hot environment.

Apart from the first temperature, all measured temperatures along the bath were less than 37.5 degree Celsius.

Two hot water baths that in each of them the baby exhibited different behavior from Vincentia. Kofi fainted and Kwesi cried and screamed. The anterior fontanelles of Kofi and Kwesi were continually under a high temperature of at least 40 to 41 degrees Celsius. Surprisingly, the temperatures on their necks increased even though no hot water was applied there. This indicated that the blood in their brains was heated and therefore, the blood in their veins flowing from their brains to their bodies was hot too. However, after reaching the maximum of 39 degrees Celsius (marked with red circle in Figure 2 - Kofi and Figure 3 - Kwesi), the temperature over their necks began to drop gradually. The conditions of the bath of Kofi and Kwesi were not identical. It took 4 minutes from the start of the bath of Kofi for the temperature over his neck to rise up to 39 degrees Celsius and 6 minutes in the bath of Kwesi. However, in both babies it took 3 minutes from the time of the maximum temperature over their neck to see a drastic change in the behavior of the babies (marked in Figure 2 and Figure 3 with blue circle). 

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Was it coincidence or something that can be explained?

Kofi and Kwesi suffered from overheating, a situation that can lead to hyperthermia. As a result of the hyperthermia there was a leakage in their Blood Brain Barriers and subsequently there was a change in the chemical balance in their brains leading to a change in their behavior. It took the same time to see a change in the behavior of both babies from the time that the temperature over their neck or from the time that there was a disfunction in their Blood Brain Barriers because the babies were both in the second week of their lives which means almost the same stage in brain development.

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What is hyperthermia? 

‘Mild’ hyperthermia is when the temperature of a body exceeds 37 degrees Celsius but remains below 40 degrees Celsius. The signs and symptoms of this heat exhaustion include intense thirst, weakness, discomfort, anxiety, headache, dizziness, and fainting.

‘Heat Stroke’ is often used in a case of severe heat illness characterized by a rise of a body core temperature above 40 degrees Celsius. This condition is associated with Central Nerve System (CNS) abnormalities [40, 41] and even with death [42]. Our brain is the control panel of our body. The walls of blood vessels of a brain have different structure from those in the body.

This blocks in a selective way entrance of harmful molecules to the brain. It is called the Blood Brain Barrier (BBB). In a mild and a sever hyperthermia the function of the Blood Brain Barrier is alerted, and harmful chemicals can enter the brain and cause damage [44].

The hypothalamus in our brain regulates the temperature our body. When the hypothalamus receives signals of heat from blood vessels it causes a reaction that results in reducing the body temperature by vasodilation (expansion of the diameter of blood vessels), sweating, panting, and other various behavioral responses that enhance heat loss [159]. However, this mechanism is also limited by the temperature and the duration of exposure to the heat. As the temperature increases and the duration of exposure to the heat increases, the hypothalamus fails to regulate the temperature of the body and the brain which leads to hyperthermia and brain damages that eventually can lead to death. 

 

Did Kofi or Kwesi suffer from hyperthermia during their baths?

Yes, they did suffer from mild hyperthermia and even heat stroke.

In the case of Kofi and Kwesi, a direct heat was applied to their heads and brains. From the moment the temperature over their necks was above 38.5 degrees Celsius it meant that the blood coming from their brains was above 38.5 degrees Celsius. Clearly the temperatures of their brains were even higher than the temperatures of their necks. Their Blood Brain Barriers stopped functioning well and allowed not desirable molecules to enter their brains and caused chemical changes in their brains. It took 3 minutes before these changes were reflected in the behavior of both babies. It took the same time because the babies were both in the second week of their life which means almost the same stage in their brain development. Literature in medical research can provides some answers to the worsening behavior of crying turning into fainting of Kofi and crying turning into screaming of Kwesi. 

• Fainting - the cries of Kofi did not turn into screams. However, he became unresponsive, and his body entered a prostrated position, leading to the suspicion that he was unconscious. It is the same position of rats under heat stroke reported by Sharma et al. A position that was eventually followed by death due to the destruction of the cells in their brains [12]. The Blood Brain Barrier that breakdowns at the temperature of approximate 38.5 degree Celsius, allows the crossing of various neurochemicals, ions, hormones and immune-active compounds that induce a wide variety of immunological, chemical and metabolic reactions within the brain [44]. Under hyperthermia of 40 degrees Celsius and above, such as Kofi suffered (temperature measured over his anterior fontanelle surface was between 40 and 41.5 degrees Celsius, Figure 2) caused the neurotransmitter glutamate level in his brain to increase. This led to imbalances in sodium ion molecules, and in turn, led to reduction in blood flow, lack of oxygen and fainting [45]. 

• Pain, Crying and screaming - Physical pain is associated with actual or potential tissue damage as defined by the International Association of Pain [43]. Therefore, when the cries of Kwesi turned into screams during the bath (Figure 3), we can conclude that not only his pain was increasing but also the potential damage to the cells of his brain. Leakage of serum proteins across the broken Blood Brain Barrier results in vasogenic brain oedema formation (an increase in water content of a tissue). As an area of the oedema is larger so is the extent of injury of cells that can lead to the death of the cell resulting in brain pathology. Not only the swollen cells are damaged, but they also put pressure on the surrounding cells as their volume increases due to the entrance of water to them and they can damage the surrounding cells too [41]. In addition, our daily life experience shows us that pressure on a tissue causes pain.

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Why should Kwesi scream during the time that his mother massaged his chest?  

The temperature over his neck was between 36 and 37 degrees Celsius. He was not screaming before when his mother massaged other parts of his body. At 40 to 43 degrees Celsius, Cerebral Blood Flow decreases, leading to a chain of events [40]. First there is a decline in oxygen uptake which disturbs the balance of O2 / CO2 gases in the blood. Eventually to compensate for the low level of oxygen a baby will start breathing fast, a situation called hyperventilation which causes discomfort in the chest [41, 46]. This can explain the worsening in the situation of Kwesi and his behavior once the mother applied pressure on the chest while massaging it. She added more pressure to an existing pressure in the chest that was caused by the hyperventilation. Therefore, his cry turned again into scream.

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Here we discussed the possible explanations for the symptoms of behaviors we observed during the baths. However, there are other changes in a brain under hyperthermia that would not be reflected during hot water bath but will be expressed later in life when a child grows. The exposure to the heat would affect many developmental processes in the brain, such as neurogenesis, migration, differentiation, distribution, expansion of the neuron, apoptosis, and structure of the neurons. All these changes have no external expression in the appearance of a baby or a child but in his or her cognitive ability or way of thinking and reasoning which will be noticed only few years later when a child start Kindergarten or Primary school. 

 

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