Miller’s journey: How cooling therapy and expert NICU care helped a newborn overcome hypoxic-ischemic encephalopathy and fat necrosis at Manning Family Children’s

Miller was born silent after an emergency C-section. After cooling therapy, eight procedures and 47 days in our NICU, he went home to the family who had waited so long for him.

For Courtney and Mark McMahon, becoming parents was a long-awaited dream. After a year and a half of trying to conceive, seeing a positive pregnancy test felt almost surreal.

"We were excited," Courtney said. "It seemed like we had waited forever."

The excitement only grew as each milestone passed. Ultrasounds—including the 22-week anatomy scan—showed a healthy baby. As Courtney’s due date approached, she dealt with the normal discomforts of late pregnancy but nothing out of the ordinary.

"I was experiencing back pain but didn’t feel any contractions,” Courtney said. “At 40 weeks, I went to my OB-GYN for a non-stress test and ultrasound. He told me the baby wasn’t ready yet because I wasn’t dilated, so we scheduled an induction for the following week."

In the days before her induction, Courtney noticed something unsettling.

"I didn't feel the baby move as much," she said.

At first, she brushed it off. The induction was only a few days away. But her worry grew, and with encouragement from Mark and a neighbor who happened to be her OB-GYN's nurse, she went to the hospital.

A life-changing day

At Touro, the monitors first showed the baby's heartbeat in the normal range but with minimal variability, a sign of mild distress. Then his heart rate suddenly began to drop.

The on-call doctor made a quick decision: "We're going to have a birthday party today." Courtney needed an emergency cesarean section.

"I was hysterical as they were rushing me to the operating room," she said. "My husband, Mark, had just stepped away to call our families."

"Once in the OR,” Courtney continue, “the nurse placed the fetal monitor and said, 'I can't detect any heart tones. We've lost the heartbeat.'”

Moments later, Mark rushed in, just in time for his son's delivery.

Miller was born in October of 2024. He was silent.

"I didn't hear him cry," said Courtney, who is a NICU nurse. Her training told her right away that something was wrong. "I saw the medical team working on him, with someone performing chest compressions."

Miller was limp. His pupils didn't respond, and his arms and legs didn't move. For 10 minutes, the neonatology team worked to resuscitate him. He was placed on a breathing tube and transferred the Neonatal Intensive Care Unit (NICU) at Manning Family Children's for cooling therapy.

Understanding HIE and cooling therapy

Miller was diagnosed with hypoxic-ischemic encephalopathy (HIE), a serious condition that happens when a baby's brain doesn't get enough oxygen and blood flow. HIE can result from complications during pregnancy, labor or delivery—such as a long or difficult labor, placental abruption, or problems with the umbilical cord.

One of the most effective treatments for HIE is therapeutic hypothermia, also called cooling therapy. Doctors lower the baby's body temperature for a set period—usually 72 hours—to reduce swelling and help prevent further brain injury. Cooling gives the brain time to heal and improves the baby's chances of a better long-term outcome.

For Courtney and Mark, those three days were agonizing.

"They kept him lightly sedated to ensure his comfort," Courtney said. "He was monitored with a continuous EEG throughout the process. It was a critical time—the longest and most anxious waiting period of our lives."

Doctors prepared the family for a difficult MRI result. In the meantime, Courtney and Mark held on to small victories: Miller’s movements, improved urine output, and signs of recovery in his liver. After cooling therapy and rewarming, an MRI showed mild to moderate brain injury on the outer part of his temporal lobe.

"We were told it could affect cognitive function, but the results were better than anyone anticipated," Courtney said. "We cried happy tears."

An unexpected complication

Just as hope began to grow, a new challenge emerged. Miller developed subcutaneous fat necrosis, a rare complication of cooling therapy. His back became red and hardened.

During cooling, babies often stay in one position for long periods, so their temperature stays steady. That can put pressure on areas like the back, and the cold can reduce blood flow to fatty tissue, making it more likely to be damaged.

Miller also had low platelets, the blood cells that help blood clot. A large hematoma—a pocket of blood under the skin—formed quickly on his back. He needed frequent blood transfusions, and his team watched closely as pressure built on his skin. With his platelet count so low, the risks of surgery had to be weighed carefully.

Specialists from neonatology, pediatric general surgery, plastic surgery and dermatology came together to discuss the best path forward. With Courtney and Mark, they decided to drain the hematoma. The surgical team removed about 250 cc of fluid (roughly a cup).

Over the next few days, the skin over the area began to die. The plastic surgery team removed the damaged skin and placed a dermal matrix and wound vac to help it heal. After several weeks, the area was ready for the final step: a skin graft. In all, Miller had eight procedures to fully reconstruct and heal the area.

Going home

Little by little, Miller grew stronger. His hematoma resolved, and his heart and lung function stabilized. After 47 days in our NICU, he was ready to go home.

On the day he was discharged, his doctors, nurses and care team lined the unit to say goodbye.

"They were our family during those first few months," Courtney said. "We leaned on them for support, guidance, and care, and we are forever grateful to them for everything they did. They were with us through some of the hardest and most uncertain times, and their dedication made all the difference."

After Miller went home, his care continued with a team of specialists at Manning Family Children's, including neurology, dermatology and endocrinology. He also saw our ENT and audiology teams to recheck his hearing, after he did not pass his newborn hearing screening on one side. Our team coordinated Early Steps services and outpatient physical therapy to support his development.

Today, Miller is 2 years old and thriving!

About the Manning Family Children’s NICU

When a newborn needs critical care, every second counts. As Louisiana’s only Level IV NICU with every pediatric medical and surgical specialty under one roof, Manning Family Children’s provides the highest level of neonatal care in the state. Our nationally ranked team, which includes the region’s top pediatric subspecialists from LSU Health New Orleans and Tulane University School of Medicine, cares for babies born as early as 22 weeks, many weighing barely a pound. In 2025 alone, our NICU cared for 272 critically ill babies transferred from 39 hospitals across the region.

Our current 35-bed NICU was built for a different era. That’s why we’re building a new 60-bed Level IV NICU with triple the space, private family rooms and advanced technology, so we can always say “yes” to the babies who need us most. It’s set to open in 2027.

Your support makes it possible. Every gift means more miracles, more birthdays and more first steps for Louisiana’s littlest.

Learn more about our NICU >> | See plans for our new NICU >> | Support Louisiana’s Littlest >>

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Please note: The images in this post are for artistic and marketing purposes only. Our precious babies in the NICU are on continuous cardio-respiratory monitoring. Parents and caregivers should always follow the AAP safe sleep guidelines and under no circumstances should babies at home be placed prone to sleep, or have items such as toys, loose bedding, or blanket rolls in their cribs.