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It has been a busy week of new research being published and shared, and while we regularly share these in our Advocacy & Research group, this week seemed like a good time to post in one easily accessible area. As always, we share relevant research that is focused on the many aspects of HIE — decreasing the impact and incidence of HIE, diagnostics, new findings, information that may help families in decision-making for subsequent pregnancies and more. It is our goal to educate families to understand the context and nuances of published research, and empower them with information to make the best decisions for their children, themselves and their families.
So, let’s get to it!
Research has shown that COVID infection can cause many adverse neonatal outcomes including prematurity, brain bleeds, stillbirth and yes, HIE. Because SARS-COV-2 is a novel virus, it was not a causation of HIE until it spread throughout the world.
We have many families in our network whose babies have been diagnosed with HIE from in utero, typically whose mothers were very ill with COVID, as one of the landmarks of more severe COVID illness is decreased oxygenation, and in pregnant mothers that can also impact the oxygenation in the placenta.
This new analysis published in JAMA shows the statistically significant incidence and difference between mRNA vaccinated and unvaccinated mother/baby dyads in regards to adverse neonatal outcomes, with those specifically analyzed by morbidity — bleeds, circulatory, neuro, GI, pulmonary — and mortality.
In comparing the unvaccinated cohort to the vaccinated, unvaccinated mother/baby dyads had a 40% greater incidence rate of HIE than the vaccinated cohort.
Vaccination against COVID in pregnancy has not been associated with adverse pregnancy outcomes, as many feared early on in the pandemic.
As many parents look to have additional babies post-HIE in our network, and families everywhere look to consider evidence and data to decrease risk factors for adverse outcomes, we share relevant data and research as a part of our mission to reduce the incidence and impact of HIE.
Researchers from the Imperial College London published research diving into why some babies may respond to therapeutic hypothermia, while others may not.
In this research, they looked at patterns of “gene expression” — that expression can change over time, and is NOT the same as having a specific, identified genetic diagnosis. Genes express themselves differently during HIE and other illnesses than in a more stable state.
They found a distinct difference and gene expression pattern in babies that experienced intermittent, chronic HIE in utero brought on by multiple chronic stresses vs. those with acute HIE around birth. Babies with the chronic HIE in utero were studied as a part of the HELIX trials that showed therapeutic hypothermia actually increased mortality and morbidity.
This lab gene expression testing could lead to developing a simple, fast blood test done at birth to better identify HIE more clearly, and lead to further targeted treatments, which would also improve certainty for neonatologists in diagnosing HIE to counsel and educate families.
We know there are cases where tracings miss fetal distress that can lead to HIE, when a maternal pulse is not traced at the same time. The largest study of its kind was recently published (pre-proof) in the American Journal of Gynecology which analyzed almost 214,000 spontaneous full-term births in maternity hospitals in Finland between 2005 and 2023.
The study included the largest CTG dataset ever published. that showed a significant reduction in neonatal encephalopathy, which HIE is the leading cause of, in mother/baby dyads that had internal monitors placed combined with maternal pulse tracking vs. CTG external tracing alone — which is the most common tracing method universally used.
“The study demonstrated that a newborn monitored during labor with external fetal heart rate monitoring alone had a 1.6-fold risk of neonatal encephalopathy (HIE is the top cause of NE) and a 2.3-fold risk of severe umbilical cord blood acidemia compared to those monitored with an internal electrode attached to the skin of the fetal head (internal monitoring) or by concurrent external fetal heart rate monitoring and maternal pulse recording.”
As with other research we share for families in our community, this is most applicable for families looking to decrease risk factors in future pregnancies, and for the general public to understand what monitoring and interventions may decrease the risk of HIE.
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