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We're especially proud to share this one — a new commentary in Pediatric Research co-authored by Hope for HIE, alongside leading neonatal experts, on one of the most genuinely uncertain questions in HIE care: whether to cool babies born at 35 weeks' gestation.

The controversy
Cooling is firmly proven for term and near-term babies with moderate-to-severe HIE (more than 1,500 infants in trials, with about a 25% reduction in death or major disability). But for babies born right at 35 weeks, the evidence is thin and conflicting. A recent randomized trial in late-preterm infants (33–35 weeks) found no clear benefit and a possible signal of harm — but it included only 48 babies at 35 weeks and wasn't designed to answer the 35-week question. Meanwhile, real-world data from 22 centers (373 babies at 35 weeks) showed lower mortality (14.1% vs 17.9%) and that cooling continues in everyday practice. In February 2026, the AAP updated its guidance: the evidence is limited, and the decision should involve parental discussion and shared decision-making.

What's happening in practice
Practice varies widely. After the new data and AAP update, the share of centers offering cooling at 35 weeks fell from 42% to 27%, and 21% said they'd no longer offer it — while about half of providers won't change their approach. And shared decision-making, though recommended, is used inconsistently: only 23% of centers said they always use it here.

What this means
The authors make the case that cooling at 35 weeks is a "preference-sensitive" decision — both cooling and not cooling can be medically reasonable — so the path forward is honest, shared conversations between families and care teams, with transparent talk about what's known and unknown, and better clinician training to support those conversations. They also argue that families should help shape the research itself, since parents often prioritize outcomes (quality of life, function, lived experience) that differ from traditional trial endpoints. Given how rare HIE at 35 weeks is, pragmatic, parent-informed study designs may generate meaningful answers faster than traditional trials. Bottom line: when the evidence can't decide for us, families belong at the center — in the decision, and in the research. This commentary is a direct expression of Hope for HIE's mission, and we're honored to be part of it.

Reference: El-Dib M, Inder T, Jalowsky M, Pilon B, Chalak L. Therapeutic hypothermia at 35 weeks' gestation: navigating controversy between randomized evidence, real-world practice, and shared decision-making. Pediatric Research. 2026.

For years, the answer to "Can I hold my baby?" during cooling was often "not yet." Cooling treatment (therapeutic hypothermia) requires keeping a baby's body temperature low for 72 hours, and traditional skin-to-skin holding wasn't considered possible without raising that temperature. So many parents have shared how painful that separation is in the very first days. As one mom in our community put it: when she was finally able to hold her son, "it felt like all his stress melted away."

But a growing body of research is showing that a modified form of holding — with the cooling blanket still in place — is safe and feasible. This new study goes a step further and asks whether babies who were held during cooling actually had different outcomes in the NICU.

The Study: Does holding during cooling affect NICU outcomes?

A new study in the Journal of Perinatology looked back at 379 babies with HIE treated with cooling at two NICUs in Northern California between 2017 and 2024.

What they wanted to know
The researchers asked two questions: which babies tend to get held during cooling, and whether being held was connected to better short-term outcomes — things like how soon a baby reached full feeding by mouth, how long they stayed in the hospital, and whether they were receiving breastmilk when they went home.

What they found
Only about 1 in 4 babies (28%) were held during cooling — and holding wasn't offered evenly. Babies were less likely to be held if they were more critically ill, were on a breathing tube, had public insurance, or were identified as Hispanic, Asian, or Black.

After accounting for how sick each baby was and other factors, babies who were held during cooling:

• Reached full feeding by mouth sooner
• Had a shorter hospital stay (about 5 days shorter, on average)
• Were more likely to be receiving breastmilk at discharge (about 2.5 times more likely)

What this means
Holding during cooling appears to be connected to meaningful, positive outcomes — even when it's a modified hold rather than traditional skin-to-skin. The researchers can't say for certain that holding caused these better outcomes (babies who were more stable may have been chosen for holding in the first place), but the findings line up with everything we know about why closeness between a parent and baby matters: it can lower stress for both, support feeding, and strengthen that early bond.

From evidence to action: the Hold-a-thon and Polar Bear Care

Studies like this one tell us that holding is safe and beneficial. The harder question is how to make it happen consistently, in every NICU, for every family. Because right now, it isn't. A recent international survey found that only about 38% of NICUs offered holding during cooling — a wide gap between what the evidence supports and what families actually experience. As this study showed, that gap often falls hardest on families who are already facing the most barriers.

That gap is exactly what the HIE Hold-a-thon was created to close. This April, during HIE Awareness Month, Hope for HIE and the Newborn Brain Society partnered to sponsor the inaugural Hold-a-thon — with more than 40 NICUs across multiple countries committing to launch new or revised holding protocols at the same time. There's real power in that kind of coordinated change: clinicians know they aren't doing it alone, and families everywhere get the same message — this matters, and it's time.

At the heart of the initiative is Polar Bear Care, a framework that brings six principles of trauma-informed care into parent holding, designed specifically for the unique needs of babies receiving cooling for HIE. Whether you're a parent hoping to hold your baby or a clinician working to make it possible, the tools and resources — including readiness assessments, sample protocols, and family education materials — are freely available at PolarBearCare.org.

This is what it looks like when research credibility and lived experience come together: evidence becomes practice, and practice becomes the moment a parent finally gets to hold their baby.

Why this matters for families

For families in the HIE community, this study offers both reassurance and a call to action:

• Holding your baby during cooling may be possible, and it may matter more than we realized.
• The benefits aren't reaching every family equally — and that gap needs to close.
• Family presence isn't "extra." It's part of care.

If your baby is going through cooling, it's always worth asking your care team about holding and what's possible in your NICU. Every unit is different, and the answer may depend on your baby's specific situation — but it's a conversation worth having, and the resources at PolarBearCare.org can help you start it. And for the families who weren't able to hold during those early days, please know this: the bond you build with your child is not defined by one moment in the NICU. There are countless ways that connection grows, and it continues long after you leave those doors.

At Hope for HIE, we'll keep advocating — alongside partners like the Newborn Brain Society — for family-centered care that treats parents as essential partners, and for every family to have the same opportunity to be close to their baby when it matters most.

Reference

Nguyen TT, Glass HC, Chan N, Taketa E, Pineda R, Cornet MC, Miller MJ. Association of parental holding during therapeutic hypothermia and NICU outcomes for infants with hypoxic-ischemic encephalopathy. Journal of Perinatology. 2026.

👉 Stay connected with Hope for HIE to learn more about the latest research, resources, and support for families and professionals working together to improve outcomes — and visit PolarBearCare.org to learn how holding during cooling is becoming the new standard.

Babies who have seizures in the newborn period — including many babies with HIE — are at higher risk of developing epilepsy later in childhood. But right now, there's no reliable way to know which babies those will be, leaving many families in a stressful "wait and see." A new study in the Journal of Neuroinflammation asked whether a baby's blood could offer earlier answers.

What they wanted to know
Researchers wanted to find out whether specific proteins and genetic signals (called microRNAs) measured in a baby's blood — in the days right after newborn seizures — could help predict which babies go on to develop epilepsy by age 2. Just as importantly, they wanted to understand why epilepsy develops, to point toward possible treatments.

What they found
The team studied two groups of babies who had seizures after brain injury: 35 babies in the NSR-RISE study (seizures from a range of causes) and 40 babies with HIE from the HEAL trial. Blood was collected 48–96 hours after seizures began, and the children were followed to age 2.

• About 15–20% developed epilepsy by age 2.
• Babies who later developed epilepsy had higher levels of IL-1β (a marker of inflammation) and higher UCHL1 (a marker of brain-cell injury). Lower growth hormone was also linked to epilepsy in one group.
• When these blood markers were added to the usual clinical signs, the ability to predict epilepsy improved sharply in this early analysis.
• The underlying biology pointed, again and again, to inflammation as a driving force.

What this means
This is an early but meaningful step toward a future blood test that could flag — soon after birth — which babies are at highest risk for epilepsy, so families and care teams aren't left only to wait and watch. Even more hopeful: by pinpointing inflammation as a likely driver, the study points to a target. If inflammation helps cause epilepsy, future treatments might be able to lower the risk, not just predict it. These are small cohorts (75 babies in total) and the findings will need to be confirmed in larger studies before becoming a test families can use — but the direction is promising.

For families whose babies had seizures in the NICU, the question "will my child develop epilepsy?" can be one of the hardest parts of the journey. Research like this brings the field closer to clearer answers, earlier. This work is part of the Neonatal Seizure Registry (NSR) — a multi-center research collaborative dedicated to improving care and outcomes for babies with neonatal seizures — and Hope for HIE is proud to be a long-standing organizational partner, helping keep the research grounded in the questions that matter most to families.

What's Next?
Biomarkers can also be a helpful tool to develop precision medicines and therapies. Will we be able to one day plug in a therapeutic for babies with HIE to specifically and better treat their seizures, and potentially prevent epilepsy in these babies? Researchers are looking at moving this science forward.

The science only moves forward with investment in research, which faces many hurdles and legislative actions to protect and increase funding.

Reference: Numis AL, Shellhaas RA, Soul JS, et al. Mechanistically informed circulating biomarkers are associated with acquired epilepsy after neonatal brain injury. Journal of Neuroinflammation. 2026.

HIE is increasingly understood as a whole-body condition, not only a brain injury. A new commentary in the Journal of Perinatology turns the spotlight on the heart — and tackles a surprisingly unsettled question: when should a baby with HIE have a heart ultrasound (echocardiogram)?

The big idea
HIE affects more than the brain. Both the original loss of oxygen and the cooling treatment that follows can change how the heart pumps, the blood pressure inside the lungs, and circulation throughout the body — and these can shift from day to day across the first week of life. Heart involvement after HIE is common, ranging from mild and silent to serious enough to need medication support. Importantly, earlier research has shown that early heart trouble — especially involving the right side of the heart in the first 24 hours — is linked to worse long-term brain and developmental outcomes. The heart and brain are connected, and caring for one may help protect the other.

What they propose
The authors note there's currently little guidance on the basic question of when to scan the heart, and practice varies widely — in one survey, only about 31% of centers routinely performed a heart scan before problems appeared. Part of the difficulty is that a baby's blood pressure can look normal even when their circulation is actually struggling, so clinical signs alone can miss trouble. They propose a structured approach for every baby with HIE undergoing cooling:

• A baseline heart scan in the first 24 hours — sooner (within 12 hours) for babies who are unstable or on a breathing tube.
• Repeat scans at vulnerable moments — including during cooling and especially rewarming, or any time a baby is unstable or there's concern about high blood pressure in the lungs.
• A final check 12–24 hours after rewarming, since heart dysfunction can linger into the first week.
• Treating the scan not as a one-time test, but as an ongoing tool used alongside clinical and lab signs to guide care.

What this means
This is an expert-proposed framework rather than a completed study, and the authors are clear that larger, multicenter studies are still needed to confirm the best timing and whether this approach improves outcomes. But the takeaway matters for families: good HIE care is about the whole baby, not just the brain — and close, well-timed attention to the heart may be an important part of protecting the brain. It's also a push toward more consistent care, so that babies at hospitals without specialized heart-imaging programs can benefit from the same proactive monitoring as those at large centers.

Reference: Hari Gopal S, Levy P, Mathur AM. Timing of echocardiography in the hemodynamic assessment of neonatal hypoxic-ischemic encephalopathy. Journal of Perinatology. 2026.

Babies undergoing cooling for HIE many times need sedation — not only for comfort, but because shivering and physiological stress raise the body's metabolic demand and can work against the very brain protection cooling is meant to provide. For years that has meant opioids (like morphine or fentanyl) or benzodiazepines (like midazolam), both of which carry real downsides. A new commentary in Pediatric Research weighs the evidence for a newer option: dexmedetomidine.

The big idea
Opioids can cause breathing suppression, low blood pressure, delayed feeding, and withdrawal; midazolam carries preclinical concerns about toxicity to the developing brain. Dexmedetomidine, a different class of sedative, is increasingly used as an alternative — and the commentary reviews a 163-baby study (Chamzas et al.) comparing it to opioids during cooling.

What they found
The underlying study reported real, tangible gains: about 50% less opioid exposure (46 vs 95 µg/kg) with fewer rescue doses, babies reaching full feeding by mouth roughly a day earlier, and comparable comfort (similar sedation scores). The catch: about 41% of babies developed bradycardia (a slowed heart rate), and the drug was stopped in nearly 30%.

What this means
The commentary's key nuance is that cooling and dexmedetomidine both slow the heart, so a low heart rate may often be expected rather than dangerous — what matters is whether it's actually affecting the baby's circulation. The authors argue for standardized, heart-function-guided protocols rather than reflexively stopping the drug based on heart rate alone (and note that cooling slows how fast the body clears the drug, so careful dosing matters, especially in smaller babies). They also raise an intriguing idea: a lower "anti-shivering" dose might capture the benefits with less heart-rate risk. The biggest open question — long-term brain development — can't be answered by a look-back study, and is being tested in the ongoing DICE trial (dexmedetomidine vs morphine, with developmental follow-up). Bottom line: a promising, opioid-sparing option that can help babies feed sooner, best paired with careful monitoring.

Reference: Srinivasan N, Harijith A. Commentary: Warming too soon? A cautious endorsement of dexmedetomidine in neonatal therapeutic hypothermia. Pediatric Research. 2026. (Commentary on Chamzas et al.)

HIE research is increasingly looking beyond cooling for ways to protect — and even repair — the newborn brain. One surprising candidate is something many families already provide every day: breastmilk. A new commentary in Pediatric Research explores whether fresh breastmilk, given as a few drops in the nose, could one day become a neuroprotective therapy for babies with HIE.

The big idea
Breastmilk is far more than nutrition. It's a living fluid containing growth factors, hormones, immune cells — and live stem cells, including cells that can develop into neurons and other brain cells in the laboratory. Early milk (colostrum) is especially rich in them. In animal studies, stem cells from breastmilk have even traveled to the brain and matured into brain cells. That's led researchers to a striking question: could breastmilk itself be repurposed as a gentle "cell therapy" to help protect or repair the injured newborn brain? The nose is a promising delivery route — it's richly supplied with blood vessels and sits along a direct path to the brain, and in lab models, stem cells given in the nose can migrate toward areas of brain injury.

What they're exploring
The commentary accompanies a small feasibility study (called F-NEO-BRIGHT) in which 10 babies with moderate-to-severe HIE were given a few drops of fresh breastmilk in each nostril twice a day — about 1.6 mL daily — from the first 48 hours of life through day 28. After some training, parents gave the drops themselves, both in the hospital and at home. The approach was safe, well-tolerated, and embraced by families and staff. The appeal is clear: unlike lab-grown stem cell therapies — which are complex, expensive, and need special storage — fresh breastmilk is widely available, essentially free, needs no processing, and brings its own mix of helpful ingredients. Since milk is already expressed many times a day for feeding, a small amount could be repurposed for this with minimal added effort or cost.

What this means
It's important to be clear about where this stands: this is an early idea, not a proven treatment. So far, researchers have shown only that giving fresh breastmilk in the nose is feasible and safe — not that it improves outcomes in HIE. Most existing clinical evidence comes from a few small studies in premature babies with brain bleeds, and real unknowns remain: the number of stem cells in breastmilk varies widely from person to person, the milk must be fresh (refrigeration reduces, and freezing destroys, the stem cells), and the right dose and timing aren't yet known. Larger, carefully designed trials are needed before this could become part of care.

Still, the promise is genuinely exciting — especially for equity. If it proves effective, intranasal breastmilk could be one of the few neuroprotective options usable almost anywhere in the world, including settings without expensive equipment or cold storage. And like skin-to-skin holding, it's something parents could do themselves — another way for families to be active partners in their baby's care.

A note: not every family is able to provide breastmilk, and that's okay. This research is about understanding the biology of a possible future therapy — not a judgment about how any baby is fed. There are many paths through HIE care, and what matters most is that every family is supported.

Reference: Martinello KA, Pang R, Lowdell MW, Robertson NJ. "Breast is Best": does this also apply to neonatal neuroprotection? Pediatric Research. 2026. (Commentary on the F-NEO-BRIGHT feasibility study, Tarjanyi et al.)