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Children's Researchers Focus on Biomarkers to Treat Neonatal Brain Injury

Washington, DC --To improve treatments of babies with perinatal hypoxic ischemic encephalopathy (HIE), a major cause of brain injury in newborns, Children’s National Health System researchers have focused on a physiological biomarker, Heart Rate Variability (HRV), which can help better predict neurological outcomes, including whether different cooling patterns can improve care.

Their study was published in June in the Journal of Perinatology.

 A key finding is the recommendation to tailor therapies to an individual’s biological profile and ongoing response to treatment and evaluate whether heart rate variability measures can be predictive of a child’s neurological outcome. 

The study showed that biomarkers can change at different times, and the cooling process may need to change as well. Heart Rate Variability (HRV) is most impacted in brain-injured patients during two key periods, at 24 hours after birth and after 80 hours. Cooling procedures have been the hallmark of treating babies with HIE, but 40 percent of children treated this way continue to have moderate-to-serve disabilities or die. HIE is a major cause of long-term neurological complications, from mild to severe, including mental retardation and cerebral palsy.

The study’s authors included members of Children’s National staff representing a joint program that includes neonatology, neonatal neurology, and fetal medicine. RB Govindan, PhD, director of advanced physiologic signals lab, is a mathematician who represents Fetal Medicine. Dr. Govindan examines variables of biomarkers and diagnostic testing and the scope of how much a baby’s brain may be injured. Others include Taeun Chang, MD, a neonatal neurologist who is director of the Neonatal Neurology Program in the division of Neurophysiology, Epilepsy, and Critical Care and An Massaro, MD, a neonatologist who is co-director of research, division of Neonatology. 

“This HRV research is something being done jointly between all three programs,” says Dr. Chang. “The beauty of doing research here is that we can pull expertise from across centers and disciplines and are not confined by traditional boundaries. We are asking RB (Govindan) to use his mathematical expertise, which he usually applies to look at fetal physiology, to examine physiologic data that (Dr. Massaro) has been collecting on our cooled infants.”

The Neonatal Neuroprotection Program has an array of specialists from different disciplines at Children’s National who ensure prenatal and postnatal care is provided for a range of conditions, especially comprehensive ones, and tailored to each patient. 

Having a mathematician on the healthcare team is a significant factor in evaluating heart rate analysis and other metrics, the researchers say. After exposure to change, “there may be other processes in the brain, which can lead to injury, and we can slow down the processes by cooling,” says Dr. Govindan. 

Dr. Massaro says the team’s study reflects an evolving personalized medicine structure “to tailor treatments down the road. We need to do more to help kids beyond cooling, used as a blanket treatment for kids. Biomarkers are helpful if we don’t know the right variation of care.”

Through their work, Children’s physicians answer a “question that is most important to parents: how is my child going to do five years from now,” says Dr. Chang.

Contact: Joe Cantlupe or Emily Hartman at 202-476-4500.


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