Research at neobrainlab for parents of babies who need hypothermia or cooling treatment after birth; birth asphyxia; cooling; hypothermia; hypoxic-ischemic encephalopathy; neobrainlab; neobrainparents; neonatal encephalopathy; NICU; neonatal intensive care unit; parents.
Research at NeoBrainLab
Many labs around the world are working to improve the care and management of babies who have suffered from birth asphyxia. If you are interested in learning more about this, ask your baby’s doctor if this type of research is occurring at your hospital.
Here is what we have done and what we do at the NeoBrainLab:
1. Brain imaging study
The current standard of care to evaluate brain damage in babies who have suffered from birth asphyxia and who were treated with hypothermia is to perform a brain imaging (magnetic resonance imaging, MRI) around day 7–10 of life, after the hypothermia treatment is complete.
The NeoBrainlab was the first research group to perform brain imaging exams during hypothermia treatment, while safely continuing to administer the treatment. With our imaging study, we have found that we already can find out on day 2 of life (during hypothermia treatment) whether babies will develop brain damage. Being able to perform these types of exams has important implications for future research, since it permits doctors to identify which babies could potentially benefit from additional therapies being investigated to improve outcomes after birth asphyxia.
We found that hypothermia, as it is currently administered, does not prevent the harmful increase of blood flow to the brain in the babies who develop brain damage, which helps to explain, in part, why this treatment is not as effective with these babies. We also found that blood flow to the brain remains increased in the damaged brain areas for as long as 10–30 days following birth asphyxia, which suggests that the events leading to the development of brain damage may continue to remain active during that time. We found that brain damage, especially in the white matter, has ongoing effects that modify the wiring of the normal brain up to day 10 or 30 of life. Thus, the window of opportunity to repair brain injury may be longer than doctors originally expected (i.e., a few days/weeks instead of a few hours). This new understanding is why researchers are now trying to determine whether appropriate interventions beyond 72 hours of life may still promote recovery.
2. Laboratory study
In newborn babies and in an animal model of birth asphyxia, we found that the persistent increased blood flow to the brain around day 10 and 30 of life corresponded to an increase in the number of small brain vessels, which we believe are involved in the repair processes. This growth of new small brain vessels may represent a potential target for new treatments to repair brain damage in babies.
In the animal model of birth asphyxia, we tested the effect of the drug called sildenafil to repair brain damage with promising results. Brain damage decreased, inflammation decreased, and the growth of new brain cells was stimulated. We also found that in addition to the beneficial effects on the brain, the positive effects of sildenafil were seen in the retina (i.e., the layer of eyes cells sending signals to the brain necessary for vision), which also can be injured after birth asphyxia.
3. Study to repair brain damages in babies—RECRUITING
Currently, no treatment exists for babies to repair the brain damage secondary to birth asphyxia. Ongoing studies around the world are testing possible additional treatments aimed at the prevention of further damage to the brain after birth asphyxia. However, at this time, no study is targeting treatments to repair injury once it has occurred.
In July 2016, the NeoBrainLab launched a new research study to test a medication, which for the first time aims to try to repair brain damage in babies who have suffered from birth asphyxia. If your baby is enrolled in this study, brain imaging will be performed on day 2 of life (while he/she is treated with hypothermia) to evaluate whether he/she already has any evidence of brain damage; if injury is seen on the brain imaging, your baby would be assigned by chance to either receive the study drug (sildenafil) or a placebo (a substance that looks like the study drug but that contains no active ingredients) for 7 days. Be assured that all babies, whether or not participating in the study, will be followed closely and receive excellent care.
Presently, the study is underway in only one NICU (the Montreal Children’s Hospital), although we hope to soon expand it to other NICUs.