Early Biomarkers of Neonatal Encephalopathy: Evidence from Antenatal and Perinatal Studies

About the Project

Neonatal encephalopathy (NE) remains a primary cause of permanent neurological impairment and long-term disability worldwide. While significant progress has been made in postnatal management, such as therapeutic hypothermia, there remains a critical diagnostic lag in our ability to identify at-risk infants before birth. Current clinical practice is often reactive, focusing on the neonate only after symptoms like seizures or altered mental status appear.

This project seeks to shift the clinical paradigm from rescue to proactive prevention. By synthesizing evidence on antenatal and intrapartum diagnostic markers, such as biochemical indicators and Doppler velocimetry, alongside intrapartum clinical events, including CTG patterns, we aim to identify the early "red flags" of brain injury.

Bridging the gap between obstetrics and neonatology, this research evaluates how prenatal stressors culminate in neurological distress. Our goal is to provide a comprehensive overview of existing literature, highlighting critical gaps in early diagnostic tools. By establishing a clearer trajectory of risk from the womb to the delivery room, we can empower clinicians to intervene earlier, optimize delivery timing, and ultimately improve the life-long health outcomes for the most vulnerable newborns.

Project Objectives

• To identify antenatal diagnostic markers that have been studied in relation to the development of neonatal encephalopathy.
• To evaluate intrapartum diagnostic markers, including fetal monitoring findings and acute obstetric events, that are associated with neonatal encephalopathy.
• To identify gaps and limitations in the existing literature regarding early diagnostic markers of neonatal encephalopathy, to guide future research directions.

Methodology / Approach

This systematic review follows a rigorous protocol to identify early warning signs of neonatal encephalopathy (NE) before and during birth. By moving the focus away from postnatal care, this study aims to build a predictive framework for identifying at-risk infants. The target population comprises fetuses during the intrapartum and antenatal periods, and pregnant women.

Search Strategy and Study Selection: The review will involve a comprehensive search across major medical databases, including PubMed, Embase, Web of Science, and the Cochrane Library. To ensure the most current data is captured, ongoing trials will also be screened via ClinicalTrials.gov and the WHO registry. Using Covidence software, two independent reviewers will screen titles and abstracts, resolving any conflicts through a third reviewer. This process will be transparently documented using a PRISMA flow diagram.

Data Extraction and Quality Assessment: For all included studies, detailed information will be extracted on study settings, participant demographics (such as gestational age and birth weight), and the specific diagnostic markers used. To ensure the evidence is reliable, the risk of bias will be rigorously assessed. Observational studies will be evaluated using the ROBINS-I tool, while any randomized controlled trials will be assessed via the Cochrane Risk of Bias tool.

Data Synthesis and Analysis: Data will be synthesized qualitatively to map out clinical trends. If the data is consistent enough, a meta-analysis will be performed using RevMan to calculate risk ratios and odds ratios, using a random-effects or fixed-effects model depending on the level of heterogeneity found.

Study Location

Not applicable. This project involves systematic review and evidence synthesis rather than field-based data collection.

Target Population / Beneficiaries

• Pregnant women
• Children

Project Team​

Project Management and Coordination

Other Key Team Members

Research Partners

Supported By

Grant Status

Key Achievements

Expected Outputs / Deliverables

• Research publications
• Guidelines or recommendations

Reports and Resources

Why This Matters

By establishing a clearer trajectory of risk from the womb to the delivery room, this research aims to empower clinicians to intervene earlier, optimize delivery timing, and ultimately improve the life-long health outcomes for the most vulnerable newborns. ​

Keywords

Fetal Health; Neonatal Health; Biomarkers; Neonatal Encephalopathy; Brain Injury; Asphyxia; Hypoxic-Ischemic Encephalopathy

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