← Back to guidelines
Cardiology1152 papers

Hypoxic ischemic encephalopathy

Last edited: 4/23/2026

Overview

Hypoxic-ischemic encephalopathy (HIE) is a neurological condition resulting from perinatal asphyxia leading to inadequate cerebral blood flow and oxygen supply, causing brain injury and potential long-term disabilities 150.

Diagnosis

  • Clinical Presentation: Altered consciousness, seizures, respiratory distress 150.
  • Recommended Tests: Amplitude-integrated EEG (aEEG), conventional EEG, neuroimaging (MRI/CT), blood gas analysis 174057.
  • Grading: Sarnat grading scale for severity assessment 1753.
  • Management

  • First-Line Treatment: Therapeutic hypothermia (initiate within 6 hours of birth, target rectal temperature 33-34°C for 72 hours) 183168.
  • Adjunctive Therapies:
  • - Caffeine: To prevent apnea and improve outcomes 1. - Ferroptosis Modulators: Cannabidiol shows potential in mitigating iron-dependent injury 3. - Metabolic Support: β-hydroxybutyrate may alleviate motor impairment 6. - Electroencephalography (EEG) Monitoring: Early EEG trends guide hypothermia decisions 1840. - Anti-inflammatory Agents: RLS-0071 and quercetin show promise in reducing inflammation and oxidative damage 2558.

    Special Populations

  • Pediatrics: Therapeutic hypothermia benefits are well-established in neonates but outcomes vary 18916.
  • Comorbidities: Acute kidney injury (AKI) is a significant complication; incidence and risk factors include baseline renal function and cooling method 2735.
  • Key Recommendations

  • Initiate therapeutic hypothermia within 6 hours of birth for infants with moderate-severe HIE to improve survival and neurodevelopmental outcomes (Evidence: Strong 1868).
  • Monitor and manage acute kidney injury closely, considering baseline renal status and cooling technique (Evidence: Moderate 2735).
  • Utilize EEG monitoring for early identification of brain injury and to guide therapeutic decisions (Evidence: Moderate 1840).
  • Consider adjunctive therapies like cannabidiol and anti-inflammatory agents to mitigate secondary brain injury mechanisms (Evidence: Weak 32558).
  • Evaluate long-term outcomes using multimodal neuromonitoring and developmental assessments post-therapeutic hypothermia (Evidence: Moderate 4449).
  • References

    Showing 100 most recent of 924 indexed papers.

    1 Zhou KQ, Lam F, Bennet L, Gunn AJ, Davidson JO. Caffeine as a Treatment for Perinatal Hypoxic-Ischemic Brain Injury: The Potential Risks and Benefits. Developmental neuroscience 2026. link 2 Sinelli M, Zannin E, Kullmann GA, Lombardo I, Malpezzi E, Rinaldi A et al.. Incidence and risk factors associated with acute kidney injury in newborns receiving therapeutic hypothermia. Pediatric nephrology (Berlin, Germany) 2026. link 3 Klimiuk M, Jefimow M, Kletkiewicz H. Ferroptosis under fire: cannabidiol mitigates iron-dependent injury in differentiated human neuroblastoma cells following oxygen-glucose deprivation. Phytomedicine : international journal of phytotherapy and phytopharmacology 2026. link 4 Razmeh S, Karimi AA, Dashti AM, Vafapour F, Mousavizadeh A. Trial of Edaravone for severe hypoxic ischemic encephalopathy in adults: a double-blind placebo-controlled study. Journal of neurology 2026. link 5 Vaamonde L, Martell M, Vollono P, Gagliardi T, Fernández C, Silvera FE et al.. Key hemodynamic parameters during induced hypothermia cooling phase in healthy and injured piglets. Respiratory physiology & neurobiology 2026. link 6 Huang Z, Lin B, Li C, Huang X, Zhu L, Xu Y et al.. β-hydroxybutyrate alleviates motor impairment and neurological damage in hypoxic-ischemic encephalopathy mice. Behavioural brain research 2026. link 7 Allegaert K, Macente J, Mekahli D, van den Anker J, Annaert P, Smits A. Progression of the estimated glomerular filtration rate in asphyxiated neonates undergoing therapeutic hypothermia during the first 10 days of life. Pediatric nephrology (Berlin, Germany) 2026. link 8 Fink A, Berg MT, Soll RF, Fiander M, Hunter K, Aagerup J et al.. Therapeutic hypothermia for newborns with hypoxic-ischaemic encephalopathy. The Cochrane database of systematic reviews 2026. link 9 Blommaert D, Bos AF, den Heijer AE, Ter Horst HJ. Five-year outcomes after cooling for hypoxic-ischemic encephalopathy and predictive value of aEEG. Early human development 2026. link 10 Cicala G, Ricca O, Picilli M, Rolleri E, Perulli M, Contaldo I et al.. Epilepsy and Neurodevelopment Outcomes 24 Months after Neonatal Hypoxic-Ischemic Encephalopathy and Predictive Factors of Post-neonatal Epilepsy. Neuropediatrics 2026. link 11 Zhao Y, Zhang J, Xia Q, Yang J, Chen D, Xia Y et al.. Ultrafast ultrasound imaging reveals altered cerebral blood flow in newborn rats with hypoxic-ischemic encephalopathy. Pediatric research 2026. link 12 Zhong R, Huang H, Liang J, Lai W, Tan Y, Liu W et al.. IGF-1 ameliorates the blood brain barrier disruption induced by the neonatal hypoxia-ischemia. International immunopharmacology 2026. link 13 Håkansson G, Eriksson Westblad M, Örtqvist M, Ådén U, Blennow M, Fransson P. Motor performance and higher associative cortical networks in adolescents with neonatal hypoxic-ischaemic encephalopathy treated with therapeutic hypothermia. Developmental medicine and child neurology 2026. link 14 Zhuang X, Wu Y, Jiang G, Jin K, Li J, Li J et al.. Multi-pool chemical exchange saturation transfer magnetic resonance imaging as a molecular-specific biomarker: detecting histopathological changes in neonatal hypoxic-ischemic encephalopathy. Pediatric radiology 2026. link 15 Lee HC, Costa-Nobre DT, Katheria AC, Mausling R, Nakwa FL, Schmölzer GM et al.. Therapeutic Hypothermia in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. The Journal of pediatrics 2026. link 16 Acun C, Lavu R, Liu W, Nicoletti N, Ramsey J, Aly H. Therapeutic hypothermia in mild hypoxic ischemic encephalopathy: A clinical dilemma with uncertain long-term outcomes. Early human development 2026. link 17 Kumar Krishnegowda V, Ramaswamy VV, Bandiya P, Bandyopadhyay T, Abiramalatha T, Prasath A et al.. Early Electroencephalography and Amplitude-Integrated Electroencephalography for the Prediction of Neurodevelopmental Outcomes in Neonates with Hypoxic Ischemic Encephalopathy: A Systematic Review and Diagnostic Test Accuracy Meta-Analysis. Neonatology 2026. link 18 Fiammante M, Vermersch AI, Vidailhet M, Chavez M. A simple EEG-based tool to guide therapeutic hypothermia decisions in neonatal hypoxic-ischemic encephalopathy. Computer methods and programs in biomedicine 2026. link 19 Bi H, Le K, Xiong Q, Hu J, Wen H, Yu J et al.. Aucubin attenuates neonatal hypoxic-ischemic brain injury by suppressing NLRP3 inflammasome-mediated microglial pyroptosis. Bioorganic chemistry 2026. link 20 Rozalen W, Pinchefsky EF, Gennaoui J, Veilleux A, Marandyuk B, Nuyt AM et al.. Cerebral palsy predictive value of 4 months-AIMS in newborns with hypoxic-ischaemic encephalopathy. Pediatrics and neonatology 2026. link 21 Ruan F, Bao W, Hu J, Wen H, Wu D, Yu J et al.. TLR2 signalling triggers NLRP3 inflammasome-mediated microglial pyroptosis promotes neonatal hypoxic-ischemic brain injury. Cellular signalling 2026. link 22 Di Martino E, Vacondio D, Arroyo-García LE, Bedin M, Balasco L, Schmeh I et al.. Delayed adoptive transfer of bone marrow-derived macrophages modulates post-ischemic inflammation in a model of neonatal hypoxia-ischemia. Brain, behavior, and immunity 2026. link 23 Luo L, Zhang H, Jiang Q, Hei S, Li M, Zhang W et al.. Global Research Progress of Mitochondria and Hypoxic-Ischemic Encephalopathy: A Comprehensive Bibliometric Analysis. Journal of child neurology 2026. link 24 Sheldon RA, Jiang X, Lu F, Stewart NR, Ferriero DM. Hypothermia treatment in Hypoxia-Inducible Factor-1α Knockout Mice with Hypoxia-Ischemia. Developmental neuroscience 2026. link 25 Jackson KG, Sampson AC, Cunnion KM, Vesoulis ZA, Krishna NK. The Anti-inflammatory Peptide RLS-0071 Reduces Immune Cell Recruitment and Oxidative Damage in a Neonatal Rat Model of Hypoxic-Ischemic Encephalopathy. American journal of perinatology 2026. link 26 Wang J, Dai C, Yuan H, Tian Q, Xiao Q, Li X et al.. The YAP/SCAP/SREBP1 pathway in astrocytes: A novel target for treating neonatal hypoxic-ischemic encephalopathy. Progress in neurobiology 2026. link 27 Fernandes C, Silva FA, Oliveiros B, Pinto CR. Auditory Impairment in Infants with Neonatal Hypoxic-Ischaemic Encephalopathy: A Systematic Review and Meta-Analysis. Neonatology 2026. link 28 Dani C, Remaschi G, Benelli E, Cecchi A, Lunardi C, Fazi C et al.. Glucose-to-lactate ratio in infants with hypoxic-ischemic encephalopathy treated with hypothermia. Early human development 2026. link 29 Goussakov I, Synowiec S, Drobyshevsky A. Low-frequency TMS ameliorates neonatal hypoxia-ischemia injury by normalizing glutamatergic transmission in penumbra. Experimental neurology 2026. link 30 Agudelo-Pérez S, Troncoso G, Gutiérrez Montenegro LM, Ordoñez JL. Timing of therapeutic hypothermia and outcomes in neonates with hypoxic-ischemic encephalopathy: A cohort study in a middle-income country. PloS one 2026. link 31 Ding A, Duan G, Zhu M, Chen L, Luo J, Tan T et al.. Microglial Inhibition Promotes Proliferation and Differentiation of Neural Stem Cells via STAT3/SDF-1/CXCR4 Signaling Pathway in Hypoxic-Ischemic Encephalopathy. Glia 2026. link 32 Al Kalaf H, Martinez A, Danguecan A, Christensen R, Tam EWY, Chau V et al.. The Prognostic Weight of Clinical, Biochemical, Electrographic, and Neuroimaging Biomarkers in Perinatal Hypoxic-Ischemic Encephalopathy Spectrum. The Journal of pediatrics 2026. link 33 Jagarapu J, Angelis D, Mir IN, Kakkilaya V, Brown SL, Chalak LF. Agreement Between Telemedicine and In-Person Examination for Neonatal Hypothermia Decisions. Pediatrics 2026. link 34 Kota S, Bitar L, Sepulveda P, Norasteh S, Liu H, Chalak LF. A Pilot Study on Dynamic Multimodal Neuromonitoring for Predicting Neurodevelopmental Outcomes in Neonatal Hypoxic-Ischemic Encephalopathy. Developmental neuroscience 2026. link 35 Bozkurt O, Bagdiken EY. Early lactate elimination trend during therapeutic hypothermia predicts acute kidney injury in hypoxic ischemic encephalopathy. Pediatric nephrology (Berlin, Germany) 2026. link 36 Yu Q, Ou J, Luo Y, Shen M, Lou J, Jiang S et al.. (+)-JQ1 Upregulates SIRT3 to Suppress cGAS/STING Pathway-Mediated Neuronal Inflammation and Ferroptosis After Hypoxic-Ischemic Encephalopathy. Drug design, development and therapy 2026. link 37 Han J, He L, Chen L, Wen B, Ji J. Aagab-driven SHIP2 degradation rescues mitochondrial dysfunction in hypoxic-ischemic encephalopathy. Mitochondrion 2026. link 38 Serrenho I, Serra SC, Salgado AJ, Baltazar G. Brain on the mend: induced mesenchymal stem cell-based therapies promote functional recovery in rats with neonatal hypoxic-ischemic brain injury. Cytotherapy 2026. link 39 Bao R, Foster AN, Song Y, Vyas R, Kesri A, Eddine Toubal I et al.. BONBID-HIE 2023: Lesion Segmentation Challenge in BOston Neonatal Brain Injury Data for Hypoxic Ischemic Encephalopathy. IEEE transactions on medical imaging 2026. link 40 Gonzalez-Tamez K, Montazeri S, Ågren J, Vanhatalo S, Hellström-Westas L. Early outcome-prediction with an automated EEG background trend in hypothermia-treated newborns with encephalopathy. Pediatric research 2026. link 41 Mistry A, Imolya N, Fletcher J, Sobithadevi D, Sham D, Baucells BJ et al.. Implementation of active therapeutic hypothermia across a regional transport network for infants transferred for neonatal encephalopathy. Pediatric research 2026. link 42 Nunes VAC, Assef JE, Le Bihan DCS, Barretto RBM, Magalhães M, Pedra SRFF. Cardiovascular Performance in Neonates with Hypoxic-Ischemic Encephalopathy Under Therapeutic Hypothermia: Evaluation by Conventional and Advanced Echocardiographic Techniques. Pediatric cardiology 2026. link 43 Varga Z, Szabó M, Kói T, Kas B, Nyilas N, Dósa A et al.. Early language delay among infants with hypoxic-ischaemic encephalopathy after therapeutic hypothermia: A prospective cohort study. Early human development 2026. link 44 Zhao X, Liu L, Tu H, Zhang X, Huang Y, Zhang R et al.. Neonatal hypoxic-ischemic encephalopathy online registry in Shenzhen: protocol for a multicentre, prospective, open, observational cohort study. BMJ open 2026. link 45 Bitar L, Kota S, Machie M, Mashat S, Liu YL, Chalak LF. Multi-organ involvement in preterm neonatal encephalopathy. Early human development 2025. link 46 Sun N, Sun YY, Cao R, Chen HR, Wang Y, Fugate E et al.. Dual-modal metabolic analysis reveals hypothermia-reversible uncoupling of oxidative phosphorylation in neonatal brain hypoxia-ischemia. eLife 2025. link 47 Bamaga AK, Alwassia HK, Al-Khotani AA, Al-Bal'awi Y, Kobeisy S, Alsubaie MA et al.. Acute Kidney Injury after Hypoxic Ischemic Encephalopathy in Neonates Treated with Passive Versus Active Total Body Cooling. Therapeutic hypothermia and temperature management 2025. link 48 Reyes-Corral M, Gil-González L, González-Díaz Á, Tovar-Luzón J, Ayuso MI, Lao-Pérez M et al.. Pretreatment with oleuropein protects the neonatal brain from hypoxia-ischemia by inhibiting apoptosis and neuroinflammation. Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism 2025. link 49 Massey SL, Sandoval Karamian AG, Fitzgerald MP, Fung FW, Abramson A, Salmon MK et al.. Development of a model to predict electroencephalographic seizures in neonates with hypoxic ischemic encephalopathy treated with therapeutic hypothermia. Epilepsia 2025. link 50 Yang M, Wang K, Liu B, Shen Y, Liu G. Hypoxic-Ischemic Encephalopathy: Pathogenesis and Promising Therapies. Molecular neurobiology 2025. link 51 Barros M, Liang M, Iannucci N, Dickinson R. Xenon and Argon as Neuroprotective Treatments for Perinatal Hypoxic-Ischemic Brain Injury: A Preclinical Systematic Review and Meta-Analysis. Anesthesia and analgesia 2025. link 52 Lewis JD, Miran AA, Stoopler M, Branson HM, Danguecan A, Raghu K et al.. Automated Neuroprognostication Via Machine Learning in Neonates with Hypoxic-Ischemic Encephalopathy. Annals of neurology 2025. link 53 Cornet MC, Numis AL, Monsell SE, Chan NH, Gonzalez FF, Comstock BA et al.. Assessing Early Severity of Hypoxic-Ischemic Encephalopathy: The Role of Electroencephalogram Background in Addition to Sarnat Exam. The Journal of pediatrics 2025. link 54 Landucci E, Mango D, Carloni S, Mazzantini C, Pellegrini-Giampietro DE, Saidi A et al.. Beneficial effects of CHF6467, a modified human nerve growth factor, in experimental neonatal hypoxic-ischaemic encephalopathy. British journal of pharmacology 2025. link 55 Frymoyer A, Vasconcelos AG, Juul SE, Comstock BA, Heagerty PJ, Wu YW. On target dosing: erythropoietin exposure in neonates with hypoxic-ischemic encephalopathy in the HEAL trial. Pediatric research 2025. link 56 Solana C, Balanian N, Machado S, Binda V, Kuperman S, Gamba C et al.. Using autologous umbilical cord blood and placental cells for hypoxic-ischemic encephalopathy: an exploratory safety and feasibility study. Archivos argentinos de pediatria 2025. link 57 Fox A, Cuzzilla R, Tarrant A, Reynolds A, Geary M, Martinez-Biarge M et al.. Utility of Cranial Ultrasound to Investigate Brain Injury in Hypoxic-Ischemic Encephalopathy. Pediatric neurology 2025. link 58 Chen Z, Ruan F, Wu D, Yu X, Jiang Y, Bao W et al.. Quercetin alleviates neonatal hypoxic-ischaemic brain injury by rebalancing microglial M1/M2 polarization through silent information regulator 1/ high mobility group box-1 signalling. Inflammopharmacology 2025. link 59 Cornet MC, Gonzalez FF, Glass HC, Wu TW, Wisnowski JL, Li Y et al.. Chorioamnionitis and Two-Year Outcomes in Infants with Hypoxic-Ischemic Encephalopathy. The Journal of pediatrics 2025. link 60 Al-Ward H, Chen W, Gao W, Zhang C, Yang X, Xiong Y et al.. Can miRNAs in MSCs-EVs Offer a Potential Treatment for Hypoxic-ischemic Encephalopathy?. Stem cell reviews and reports 2025. link 61 Naik M, Warden E, Pittman R, Katakam L. Gentamicin Pharmacokinetics in Neonates Undergoing Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy. Paediatric drugs 2025. link 62 Lear BA, McDouall AJ, Lear OJ, Dhillon SK, Lear CA, Northington FJ et al.. The Potential Clinical Relevance of Necrosis-Necroptosis Pathways for Hypoxic-Ischaemic Encephalopathy. Cells 2025. link 63 Yu X, Chen Z, Ruan F, Jiang Y, Bao W, Wu D et al.. Inhibition of PAD4-mediated neutrophil extracellular traps formation attenuates hypoxic-ischemic brain injury in neonatal mice. Experimental neurology 2025. link 64 Mashat S, Bitar L, Mir IN, Leon RL, Brown LS, Chalak LF. Placental inflammatory response and association with the severity of neonatal hypoxic ischemic encephalopathy. Early human development 2025. link 65 Yang G, Wang L, Xie H, Tang X, Mukedaisihan M, Yang Y et al.. Comprehensive evaluation and diagnosis of persistent vegetative state after hypoxic-ischemic encephalopathy: a case report. Neurocase 2025. link 66 Jerez Calero A, Contreras Chova F, Benítez Feliponi Á, Azaryah H, Hurtado Suazo JA, Moreno Galdó MF et al.. Pro-inflammatory biomarkers and long term neurological outcomes in hypothermia plus melatonin treated asphyxiated newborns. A preliminary approach. Pediatric research 2025. link 67 McLean L, Dalrymple H, Sasidharan L, Grant T, Browning Carmo K. Efficacy of Therapeutic Hypothermia During Transport of Newborns With Perinatal Hypoxic-Ischaemic Encephalopathy: Experience From Newborn and Paediatric Transport Service, New South Wales. Journal of paediatrics and child health 2025. link 68 Arslan Z, Okbay Gunes A, Deveci MF, Unal Yuksekgonul A, Kasali K. The Association Between Neonatal Intensive Care Unit Arrival Temperatures and Short-Term Outcomes of Neonates with Moderate and Severe Hypoxic-Ischemic Encephalopathy. Therapeutic hypothermia and temperature management 2025. link 69 Rondagh M, de Vries LS, van Steenis A, Meder U, Szakacs L, Jermendy A et al.. Longitudinal Analysis of Amplitude-Integrated Electroencephalography for Outcome Prediction in Infants with Hypoxic-Ischemic Encephalopathy: A Validation Study. The Journal of pediatrics 2025. link 70 Pease ME, Yi E, Joshi S, Poletto E, Menkiti O, Quiñones Cardona V. In-Hospital Outcomes of Neonates with Hypoxic-Ischemic Encephalopathy Receiving Sedation-Analgesia during Therapeutic Hypothermia. American journal of perinatology 2025. link 71 van Oldenmark BO, van Steenis A, de Vries LS, Groenendaal F, Steggerda SJ. Fifteen Years of Neonatal Therapeutic Hypothermia: Clinical Trends Show Unchanged Post-Rewarming Outcomes despite Reduction in Hypoxic-Ischemic Encephalopathy Severity. Neonatology 2025. link 72 Gonzalez FF, Monsell SE, Cornet MC, Glass H, Wisnowski J, Mathur A et al.. Perinatal arterial ischemic stroke diagnosed in infants receiving therapeutic hypothermia for hypoxic-ischemic encephalopathy. Pediatric research 2025. link 73 Chan NH, Hawkins CC, Rodrigues BV, Cornet MC, Gonzalez FF, Wu YW. Neuroprotection for neonatal hypoxic-ischemic encephalopathy: A review of novel therapies evaluated in clinical studies. Developmental medicine and child neurology 2025. link 74 Lee DA, Sohn GM, Kim BJ, Yoo BC, Lee JH, Choi HJ et al.. Correlation Between Quantitative Background Suppression on EEG and Serum NSE in Patients With Hypoxic-ischemic Encephalopathy. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society 2025. link 75 LaBella M, Kelly K, Carlin K, Walsh E. Comparison of Temporal Artery and Rectal Temperature Measurement During Cooling and Rewarming in Neonates Treated for Hypoxic Ischemic Encephalopathy. Advances in neonatal care : official journal of the National Association of Neonatal Nurses 2025. link 76 Biran V, Saba E, Lapointe A, Macias CM, Mawad W, Martinez DV et al.. Cardiac function at follow-up in infants treated with therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy. Pediatric research 2025. link 77 Tran NT, Ellery SJ, Kelly SB, Sévigny J, Chatton M, Lu H et al.. Prophylactic Fetal Creatine Supplementation Improves Post-Asphyxial EEG Recovery and Reduces Seizures in Fetal Sheep: Implications for Hypoxic-Ischemic Encephalopathy. Annals of neurology 2025. link 78 Schmidt R, Welzel B, Merten A, Naundorf H, Löscher W. Temporal development of seizure threshold and spontaneous seizures after neonatal asphyxia and the effect of prophylactic treatment with midazolam in rats. Experimental neurology 2025. link 79 Adams RL, Al-Mayahi S, Mara MD. Exploring the oral health status of children living with hypoxic ischemic encephalopathy (HIE): A caregiver described self-report. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry 2025. link 80 Fajardo C, Belzu M, Bernal Benitez M, Hoyos Á, Hernández Patiño R, Monterrosa L et al.. Therapeutic hypothermia success for hypoxic-ischaemic encephalopathy in Latin America: Eight-year experience in EpicLatino Neonatal Network. Acta paediatrica (Oslo, Norway : 1992) 2025. link 81 Bernardo D, Kim J, Cornet MC, Numis AL, Scheffler A, Rao VR et al.. Machine learning for forecasting initial seizure onset in neonatal hypoxic-ischemic encephalopathy. Epilepsia 2025. link 82 Javed R, Hodson J, Gowda H. Prevalence of Pulmonary Hypertension During Therapeutic Hypothermia for Hypoxic Ischemic Encephalopathy and Evaluation of Short-Term Outcomes. Therapeutic hypothermia and temperature management 2025. link 83 Tang J, He SP, Liu YQ, Xiang YH, Yi T, Jin K. Combined model of radiomics and clinical features for predicting prognosis of term neonatal hypoxic-ischemic encephalopathy after one year: an exploratory study. BMC medical imaging 2025. link 84 Dang Y, Shen F, Wang S, Zhang Y, Lu X, Qin D et al.. Dual-Modified Mannose/RVG29 Peptide-Functionalized Lipid Nanoparticles Loaded With . Journal of integrative neuroscience 2025. link 85 J A, S S, P W, S W, P B, K M. Quality improvement and outcomes for neonates with hypoxic-ischemic encephalopathy: obstetrics and neonatal perspectives. Seminars in perinatology 2024. link 86 Francke KH, Støen R, Thomas N, Aker K. Biochemical profiles and organ dysfunction in neonates with hypoxic-ischemic encephalopathy post-hoc analysis of the THIN trial. BMC pediatrics 2024. link 87 Liu H, Xie T, Wang J, Wang X, Han J, Huang Z et al.. In situ analysis of metabolic changes under hypoxic-ischemic encephalopathy via MALDI mass spectrometry imaging. Talanta 2024. link 88 Laval N, Paquette M, Talsmat H, Marandyuk B, Wintermark P, Birca A et al.. Exposure to Maternal Diabetes during Pregnancy Is Associated with Aggravated Short-Term Neonatal and Neurological Outcomes following Perinatal Hypoxic-Ischemic Encephalopathy. American journal of perinatology 2024. link 89 Okbay Gunes A, Bozkaya A. The Association Between Hypoxic-Ischemic Encephalopathy and Thyroid Hormones. Therapeutic hypothermia and temperature management 2024. link 90 Kanmaz Kutman HG, Kadıoğlu Şimşek G, Siyah Bilgin B, Akin MŞ, Canpolat FE. Does base excess predict kidney injury in neonates with hypoxic-ischemic encephalopathy?. Early human development 2024. link 91 Bolini L, Campos RMP, Spiess DA, Lima-Rosa FL, Dantas DP, Conde L et al.. Long-term recruitment of peripheral immune cells to brain scars after a neonatal insult. Glia 2024. link 92 Grass B, Erlach M, Rathke V, Cippa G, Hagmann C, Brotschi B. Parents' Experiences of Therapeutic Hypothermia for Neonates With Hypoxic-Ischemic Encephalopathy (HIE): A Single-Center Cross-Sectional Study. Quality management in health care 2024. link 93 Kim CF, Carreon CK, James KE, Bates SV, Mueller SB, Boyd TK et al.. Gross and Histologic Placental Abnormalities Associated With Neonatal Hypoxic-Ischemic Encephalopathy. Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society 2024. link 94 Leith WM, Zeegers MP, Freeman MD. A predictive model for perinatal hypoxic ischemic encephalopathy using linked maternal and neonatal hospital data. Annals of epidemiology 2024. link 95 Varga Z, Andorka C, Pataki M, Meder U, Szakmar E, Szabo AJ et al.. Higher parental education was associated with good cognitive outcomes in infants with hypoxic-ischaemic encephalopathy. Acta paediatrica (Oslo, Norway : 1992) 2024. link 96 Li L, Lin Z, Yuan J, Li P, Wang Q, Cho N et al.. The neuroprotective mechanisms of naringenin: Inhibition of apoptosis through the PI3K/AKT pathway after hypoxic-ischemic brain damage. Journal of ethnopharmacology 2024. link 97 Battin MR, Davis SL, Gardner M, Joe P, Rasmussen M, Haas R et al.. Seizures after initiation of rewarming in cooled infants with hypoxic ischaemic encephalopathy. Pediatric research 2024. link 98 Tepe T, Satar M, Ozdemir M, Yildizdas HY, Ozlü F, Erdogan S et al.. Long-term effect of indomethacin on a rat model of neonatal hypoxia ischemic encephalopathy through behavioral tests. International journal of developmental neuroscience : the official journal of the International Society for Developmental Neuroscience 2024. link 99 Satar M, Cengizler C, Hamitoglu S, Ozdemir M. Investigation of Relation Between Hypoxic-Ischemic Encephalopathy and Spectral Features of Infant Cry Audio. Journal of voice : official journal of the Voice Foundation 2024. link 100 Aloizou AM, Labedi A, Richter D, Ceylan U, Schroeder C, Lukas C et al.. Cortical blindness as a sign of delayed post-hypoxic encephalopathy: a case report. The International journal of neuroscience 2024. link

    Original source

    1. [1]
      Caffeine as a Treatment for Perinatal Hypoxic-Ischemic Brain Injury: The Potential Risks and Benefits.Zhou KQ, Lam F, Bennet L, Gunn AJ, Davidson JO Developmental neuroscience (2026)
    2. [2]
      Incidence and risk factors associated with acute kidney injury in newborns receiving therapeutic hypothermia.Sinelli M, Zannin E, Kullmann GA, Lombardo I, Malpezzi E, Rinaldi A et al. Pediatric nephrology (Berlin, Germany) (2026)
    3. [3]
      Ferroptosis under fire: cannabidiol mitigates iron-dependent injury in differentiated human neuroblastoma cells following oxygen-glucose deprivation.Klimiuk M, Jefimow M, Kletkiewicz H Phytomedicine : international journal of phytotherapy and phytopharmacology (2026)
    4. [4]
      Trial of Edaravone for severe hypoxic ischemic encephalopathy in adults: a double-blind placebo-controlled study.Razmeh S, Karimi AA, Dashti AM, Vafapour F, Mousavizadeh A Journal of neurology (2026)
    5. [5]
      Key hemodynamic parameters during induced hypothermia cooling phase in healthy and injured piglets.Vaamonde L, Martell M, Vollono P, Gagliardi T, Fernández C, Silvera FE et al. Respiratory physiology & neurobiology (2026)
    6. [6]
      β-hydroxybutyrate alleviates motor impairment and neurological damage in hypoxic-ischemic encephalopathy mice.Huang Z, Lin B, Li C, Huang X, Zhu L, Xu Y et al. Behavioural brain research (2026)
    7. [7]
      Progression of the estimated glomerular filtration rate in asphyxiated neonates undergoing therapeutic hypothermia during the first 10 days of life.Allegaert K, Macente J, Mekahli D, van den Anker J, Annaert P, Smits A Pediatric nephrology (Berlin, Germany) (2026)
    8. [8]
      Therapeutic hypothermia for newborns with hypoxic-ischaemic encephalopathy.Fink A, Berg MT, Soll RF, Fiander M, Hunter K, Aagerup J et al. The Cochrane database of systematic reviews (2026)
    9. [9]
      Five-year outcomes after cooling for hypoxic-ischemic encephalopathy and predictive value of aEEG.Blommaert D, Bos AF, den Heijer AE, Ter Horst HJ Early human development (2026)
    10. [10]
      Epilepsy and Neurodevelopment Outcomes 24 Months after Neonatal Hypoxic-Ischemic Encephalopathy and Predictive Factors of Post-neonatal Epilepsy.Cicala G, Ricca O, Picilli M, Rolleri E, Perulli M, Contaldo I et al. Neuropediatrics (2026)
    11. [11]
      Ultrafast ultrasound imaging reveals altered cerebral blood flow in newborn rats with hypoxic-ischemic encephalopathy.Zhao Y, Zhang J, Xia Q, Yang J, Chen D, Xia Y et al. Pediatric research (2026)
    12. [12]
      IGF-1 ameliorates the blood brain barrier disruption induced by the neonatal hypoxia-ischemia.Zhong R, Huang H, Liang J, Lai W, Tan Y, Liu W et al. International immunopharmacology (2026)
    13. [13]
      Motor performance and higher associative cortical networks in adolescents with neonatal hypoxic-ischaemic encephalopathy treated with therapeutic hypothermia.Håkansson G, Eriksson Westblad M, Örtqvist M, Ådén U, Blennow M, Fransson P Developmental medicine and child neurology (2026)
    14. [14]
    15. [15]
      Therapeutic Hypothermia in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.Lee HC, Costa-Nobre DT, Katheria AC, Mausling R, Nakwa FL, Schmölzer GM et al. The Journal of pediatrics (2026)
    16. [16]
      Therapeutic hypothermia in mild hypoxic ischemic encephalopathy: A clinical dilemma with uncertain long-term outcomes.Acun C, Lavu R, Liu W, Nicoletti N, Ramsey J, Aly H Early human development (2026)
    17. [17]
    18. [18]
      A simple EEG-based tool to guide therapeutic hypothermia decisions in neonatal hypoxic-ischemic encephalopathy.Fiammante M, Vermersch AI, Vidailhet M, Chavez M Computer methods and programs in biomedicine (2026)
    19. [19]
    20. [20]
      Cerebral palsy predictive value of 4 months-AIMS in newborns with hypoxic-ischaemic encephalopathy.Rozalen W, Pinchefsky EF, Gennaoui J, Veilleux A, Marandyuk B, Nuyt AM et al. Pediatrics and neonatology (2026)
    21. [21]
    22. [22]
      Delayed adoptive transfer of bone marrow-derived macrophages modulates post-ischemic inflammation in a model of neonatal hypoxia-ischemia.Di Martino E, Vacondio D, Arroyo-García LE, Bedin M, Balasco L, Schmeh I et al. Brain, behavior, and immunity (2026)
    23. [23]
      Global Research Progress of Mitochondria and Hypoxic-Ischemic Encephalopathy: A Comprehensive Bibliometric Analysis.Luo L, Zhang H, Jiang Q, Hei S, Li M, Zhang W et al. Journal of child neurology (2026)
    24. [24]
      Hypothermia treatment in Hypoxia-Inducible Factor-1α Knockout Mice with Hypoxia-Ischemia.Sheldon RA, Jiang X, Lu F, Stewart NR, Ferriero DM Developmental neuroscience (2026)
    25. [25]
      The Anti-inflammatory Peptide RLS-0071 Reduces Immune Cell Recruitment and Oxidative Damage in a Neonatal Rat Model of Hypoxic-Ischemic Encephalopathy.Jackson KG, Sampson AC, Cunnion KM, Vesoulis ZA, Krishna NK American journal of perinatology (2026)
    26. [26]
      The YAP/SCAP/SREBP1 pathway in astrocytes: A novel target for treating neonatal hypoxic-ischemic encephalopathy.Wang J, Dai C, Yuan H, Tian Q, Xiao Q, Li X et al. Progress in neurobiology (2026)
    27. [27]
    28. [28]
      Glucose-to-lactate ratio in infants with hypoxic-ischemic encephalopathy treated with hypothermia.Dani C, Remaschi G, Benelli E, Cecchi A, Lunardi C, Fazi C et al. Early human development (2026)
    29. [29]
    30. [30]
    31. [31]
    32. [32]
      The Prognostic Weight of Clinical, Biochemical, Electrographic, and Neuroimaging Biomarkers in Perinatal Hypoxic-Ischemic Encephalopathy Spectrum.Al Kalaf H, Martinez A, Danguecan A, Christensen R, Tam EWY, Chau V et al. The Journal of pediatrics (2026)
    33. [33]
      Agreement Between Telemedicine and In-Person Examination for Neonatal Hypothermia Decisions.Jagarapu J, Angelis D, Mir IN, Kakkilaya V, Brown SL, Chalak LF Pediatrics (2026)
    34. [34]
      A Pilot Study on Dynamic Multimodal Neuromonitoring for Predicting Neurodevelopmental Outcomes in Neonatal Hypoxic-Ischemic Encephalopathy.Kota S, Bitar L, Sepulveda P, Norasteh S, Liu H, Chalak LF Developmental neuroscience (2026)
    35. [35]
    36. [36]
      (+)-JQ1 Upregulates SIRT3 to Suppress cGAS/STING Pathway-Mediated Neuronal Inflammation and Ferroptosis After Hypoxic-Ischemic Encephalopathy.Yu Q, Ou J, Luo Y, Shen M, Lou J, Jiang S et al. Drug design, development and therapy (2026)
    37. [37]
    38. [38]
    39. [39]
      BONBID-HIE 2023: Lesion Segmentation Challenge in BOston Neonatal Brain Injury Data for Hypoxic Ischemic Encephalopathy.Bao R, Foster AN, Song Y, Vyas R, Kesri A, Eddine Toubal I et al. IEEE transactions on medical imaging (2026)
    40. [40]
      Early outcome-prediction with an automated EEG background trend in hypothermia-treated newborns with encephalopathy.Gonzalez-Tamez K, Montazeri S, Ågren J, Vanhatalo S, Hellström-Westas L Pediatric research (2026)
    41. [41]
      Implementation of active therapeutic hypothermia across a regional transport network for infants transferred for neonatal encephalopathy.Mistry A, Imolya N, Fletcher J, Sobithadevi D, Sham D, Baucells BJ et al. Pediatric research (2026)
    42. [42]
    43. [43]
      Early language delay among infants with hypoxic-ischaemic encephalopathy after therapeutic hypothermia: A prospective cohort study.Varga Z, Szabó M, Kói T, Kas B, Nyilas N, Dósa A et al. Early human development (2026)
    44. [44]
    45. [45]
      Multi-organ involvement in preterm neonatal encephalopathy.Bitar L, Kota S, Machie M, Mashat S, Liu YL, Chalak LF Early human development (2025)
    46. [46]
    47. [47]
      Acute Kidney Injury after Hypoxic Ischemic Encephalopathy in Neonates Treated with Passive Versus Active Total Body Cooling.Bamaga AK, Alwassia HK, Al-Khotani AA, Al-Bal'awi Y, Kobeisy S, Alsubaie MA et al. Therapeutic hypothermia and temperature management (2025)
    48. [48]
      Pretreatment with oleuropein protects the neonatal brain from hypoxia-ischemia by inhibiting apoptosis and neuroinflammation.Reyes-Corral M, Gil-González L, González-Díaz Á, Tovar-Luzón J, Ayuso MI, Lao-Pérez M et al. Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism (2025)
    49. [49]
      Development of a model to predict electroencephalographic seizures in neonates with hypoxic ischemic encephalopathy treated with therapeutic hypothermia.Massey SL, Sandoval Karamian AG, Fitzgerald MP, Fung FW, Abramson A, Salmon MK et al. Epilepsia (2025)
    50. [50]
      Hypoxic-Ischemic Encephalopathy: Pathogenesis and Promising Therapies.Yang M, Wang K, Liu B, Shen Y, Liu G Molecular neurobiology (2025)
    51. [51]
    52. [52]
      Automated Neuroprognostication Via Machine Learning in Neonates with Hypoxic-Ischemic Encephalopathy.Lewis JD, Miran AA, Stoopler M, Branson HM, Danguecan A, Raghu K et al. Annals of neurology (2025)
    53. [53]
      Assessing Early Severity of Hypoxic-Ischemic Encephalopathy: The Role of Electroencephalogram Background in Addition to Sarnat Exam.Cornet MC, Numis AL, Monsell SE, Chan NH, Gonzalez FF, Comstock BA et al. The Journal of pediatrics (2025)
    54. [54]
      Beneficial effects of CHF6467, a modified human nerve growth factor, in experimental neonatal hypoxic-ischaemic encephalopathy.Landucci E, Mango D, Carloni S, Mazzantini C, Pellegrini-Giampietro DE, Saidi A et al. British journal of pharmacology (2025)
    55. [55]
      On target dosing: erythropoietin exposure in neonates with hypoxic-ischemic encephalopathy in the HEAL trial.Frymoyer A, Vasconcelos AG, Juul SE, Comstock BA, Heagerty PJ, Wu YW Pediatric research (2025)
    56. [56]
      Using autologous umbilical cord blood and placental cells for hypoxic-ischemic encephalopathy: an exploratory safety and feasibility study.Solana C, Balanian N, Machado S, Binda V, Kuperman S, Gamba C et al. Archivos argentinos de pediatria (2025)
    57. [57]
      Utility of Cranial Ultrasound to Investigate Brain Injury in Hypoxic-Ischemic Encephalopathy.Fox A, Cuzzilla R, Tarrant A, Reynolds A, Geary M, Martinez-Biarge M et al. Pediatric neurology (2025)
    58. [58]
    59. [59]
      Chorioamnionitis and Two-Year Outcomes in Infants with Hypoxic-Ischemic Encephalopathy.Cornet MC, Gonzalez FF, Glass HC, Wu TW, Wisnowski JL, Li Y et al. The Journal of pediatrics (2025)
    60. [60]
      Can miRNAs in MSCs-EVs Offer a Potential Treatment for Hypoxic-ischemic Encephalopathy?Al-Ward H, Chen W, Gao W, Zhang C, Yang X, Xiong Y et al. Stem cell reviews and reports (2025)
    61. [61]
    62. [62]
      The Potential Clinical Relevance of Necrosis-Necroptosis Pathways for Hypoxic-Ischaemic Encephalopathy.Lear BA, McDouall AJ, Lear OJ, Dhillon SK, Lear CA, Northington FJ et al. Cells (2025)
    63. [63]
    64. [64]
      Placental inflammatory response and association with the severity of neonatal hypoxic ischemic encephalopathy.Mashat S, Bitar L, Mir IN, Leon RL, Brown LS, Chalak LF Early human development (2025)
    65. [65]
      Comprehensive evaluation and diagnosis of persistent vegetative state after hypoxic-ischemic encephalopathy: a case report.Yang G, Wang L, Xie H, Tang X, Mukedaisihan M, Yang Y et al. Neurocase (2025)
    66. [66]
      Pro-inflammatory biomarkers and long term neurological outcomes in hypothermia plus melatonin treated asphyxiated newborns. A preliminary approach.Jerez Calero A, Contreras Chova F, Benítez Feliponi Á, Azaryah H, Hurtado Suazo JA, Moreno Galdó MF et al. Pediatric research (2025)
    67. [67]
    68. [68]
      The Association Between Neonatal Intensive Care Unit Arrival Temperatures and Short-Term Outcomes of Neonates with Moderate and Severe Hypoxic-Ischemic Encephalopathy.Arslan Z, Okbay Gunes A, Deveci MF, Unal Yuksekgonul A, Kasali K Therapeutic hypothermia and temperature management (2025)
    69. [69]
      Longitudinal Analysis of Amplitude-Integrated Electroencephalography for Outcome Prediction in Infants with Hypoxic-Ischemic Encephalopathy: A Validation Study.Rondagh M, de Vries LS, van Steenis A, Meder U, Szakacs L, Jermendy A et al. The Journal of pediatrics (2025)
    70. [70]
      In-Hospital Outcomes of Neonates with Hypoxic-Ischemic Encephalopathy Receiving Sedation-Analgesia during Therapeutic Hypothermia.Pease ME, Yi E, Joshi S, Poletto E, Menkiti O, Quiñones Cardona V American journal of perinatology (2025)
    71. [71]
    72. [72]
      Perinatal arterial ischemic stroke diagnosed in infants receiving therapeutic hypothermia for hypoxic-ischemic encephalopathy.Gonzalez FF, Monsell SE, Cornet MC, Glass H, Wisnowski J, Mathur A et al. Pediatric research (2025)
    73. [73]
      Neuroprotection for neonatal hypoxic-ischemic encephalopathy: A review of novel therapies evaluated in clinical studies.Chan NH, Hawkins CC, Rodrigues BV, Cornet MC, Gonzalez FF, Wu YW Developmental medicine and child neurology (2025)
    74. [74]
      Correlation Between Quantitative Background Suppression on EEG and Serum NSE in Patients With Hypoxic-ischemic Encephalopathy.Lee DA, Sohn GM, Kim BJ, Yoo BC, Lee JH, Choi HJ et al. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society (2025)
    75. [75]
      Comparison of Temporal Artery and Rectal Temperature Measurement During Cooling and Rewarming in Neonates Treated for Hypoxic Ischemic Encephalopathy.LaBella M, Kelly K, Carlin K, Walsh E Advances in neonatal care : official journal of the National Association of Neonatal Nurses (2025)
    76. [76]
      Cardiac function at follow-up in infants treated with therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy.Biran V, Saba E, Lapointe A, Macias CM, Mawad W, Martinez DV et al. Pediatric research (2025)
    77. [77]
    78. [78]
    79. [79]
      Exploring the oral health status of children living with hypoxic ischemic encephalopathy (HIE): A caregiver described self-report.Adams RL, Al-Mayahi S, Mara MD Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry (2025)
    80. [80]
      Therapeutic hypothermia success for hypoxic-ischaemic encephalopathy in Latin America: Eight-year experience in EpicLatino Neonatal Network.Fajardo C, Belzu M, Bernal Benitez M, Hoyos Á, Hernández Patiño R, Monterrosa L et al. Acta paediatrica (Oslo, Norway : 1992) (2025)
    81. [81]
      Machine learning for forecasting initial seizure onset in neonatal hypoxic-ischemic encephalopathy.Bernardo D, Kim J, Cornet MC, Numis AL, Scheffler A, Rao VR et al. Epilepsia (2025)
    82. [82]
    83. [83]
    84. [84]
      Dual-Modified Mannose/RVG29 Peptide-Functionalized Lipid Nanoparticles Loaded With Dang Y, Shen F, Wang S, Zhang Y, Lu X, Qin D et al. Journal of integrative neuroscience (2025)
    85. [85]
    86. [86]
    87. [87]
    88. [88]
      Exposure to Maternal Diabetes during Pregnancy Is Associated with Aggravated Short-Term Neonatal and Neurological Outcomes following Perinatal Hypoxic-Ischemic Encephalopathy.Laval N, Paquette M, Talsmat H, Marandyuk B, Wintermark P, Birca A et al. American journal of perinatology (2024)
    89. [89]
      The Association Between Hypoxic-Ischemic Encephalopathy and Thyroid Hormones.Okbay Gunes A, Bozkaya A Therapeutic hypothermia and temperature management (2024)
    90. [90]
      Does base excess predict kidney injury in neonates with hypoxic-ischemic encephalopathy?Kanmaz Kutman HG, Kadıoğlu Şimşek G, Siyah Bilgin B, Akin MŞ, Canpolat FE Early human development (2024)
    91. [91]
      Long-term recruitment of peripheral immune cells to brain scars after a neonatal insult.Bolini L, Campos RMP, Spiess DA, Lima-Rosa FL, Dantas DP, Conde L et al. Glia (2024)
    92. [92]
      Parents' Experiences of Therapeutic Hypothermia for Neonates With Hypoxic-Ischemic Encephalopathy (HIE): A Single-Center Cross-Sectional Study.Grass B, Erlach M, Rathke V, Cippa G, Hagmann C, Brotschi B Quality management in health care (2024)
    93. [93]
      Gross and Histologic Placental Abnormalities Associated With Neonatal Hypoxic-Ischemic Encephalopathy.Kim CF, Carreon CK, James KE, Bates SV, Mueller SB, Boyd TK et al. Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society (2024)
    94. [94]
    95. [95]
      Higher parental education was associated with good cognitive outcomes in infants with hypoxic-ischaemic encephalopathy.Varga Z, Andorka C, Pataki M, Meder U, Szakmar E, Szabo AJ et al. Acta paediatrica (Oslo, Norway : 1992) (2024)
    96. [96]
    97. [97]
      Seizures after initiation of rewarming in cooled infants with hypoxic ischaemic encephalopathy.Battin MR, Davis SL, Gardner M, Joe P, Rasmussen M, Haas R et al. Pediatric research (2024)
    98. [98]
      Long-term effect of indomethacin on a rat model of neonatal hypoxia ischemic encephalopathy through behavioral tests.Tepe T, Satar M, Ozdemir M, Yildizdas HY, Ozlü F, Erdogan S et al. International journal of developmental neuroscience : the official journal of the International Society for Developmental Neuroscience (2024)
    99. [99]
      Investigation of Relation Between Hypoxic-Ischemic Encephalopathy and Spectral Features of Infant Cry Audio.Satar M, Cengizler C, Hamitoglu S, Ozdemir M Journal of voice : official journal of the Voice Foundation (2024)
    100. [100]
      Cortical blindness as a sign of delayed post-hypoxic encephalopathy: a case report.Aloizou AM, Labedi A, Richter D, Ceylan U, Schroeder C, Lukas C et al. The International journal of neuroscience (2024)

    HemoChat

    by SPINAI

    Evidence-based clinical decision support powered by SNOMED-CT, Neo4j GraphRAG, and NASS/AO/NICE guidelines.

    ⚕ For clinical reference only. Not a substitute for professional judgment.

    © 2026 HemoChat. All rights reserved.
    Research·Pricing·Privacy & Terms·Refund·SNOMED-CT · NASS · AO Spine · NICE · GraphRAG