Subtle neurologic injury in newborns can be difficult to detect, but identifying this early is crucial in preventing further damage and supporting a baby’s lifelong brain development and brain health. To help protect the newborn brain, Children’s Hospital Los Angeles (CHLA) has integrated neurocritical care into its Level IV Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit (NICU) since 2013. One of only eight centers nationwide with dedicated neurocritical NICU expertise, CHLA begins this care before birth and continues it well into childhood and even into young adulthood. That comprehensive, 24/7 care is delivered throughout the hospital by the only Board-certified pediatric neurocritical care neurologists in Southern California, as well as by neonatologists and pediatric neuroradiologists, cardiologists, nurses, physical therapists, and other subspecialists.
“Decisions made in the NICU can influence a child’s outcomes for years to come,” says Philippe Friedlich, MD, MSEpi, MBA, Co-Director of the Fetal and Neonatal Institute at CHLA and the Teresa and Byron Pollitt Family Chair in Fetal and Neonatal Medicine. “It’s crucial to have multidisciplinary teams with specialized critical‑care training who understand how a newborn’s brain responds to injury.”
Pediatric critical care neurologist Eugenia Ho, MD, MPH, and neonatologist Eni Jano, MD, share how advances in monitoring, assessment, and research are shaping a more proactive, integrated approach to newborn brain health—and why CHLA serves as the regional leader in complex neurological care for infants.
Continuous monitoring detects subclinical seizures
Newborns are more prone to seizures than any other age group, but many neonatal seizures are “quiet,” with few—if any—overt clinical signs. To detect seizure activity and evaluate the baby’s brain activity, CHLA monitors high‑risk newborns in the NICU using continuous video encephalogram (EEG) and amplitude‑integrated EEG (aEEG). More importantly, these studies are reviewed around-the-clock and interpreted by pediatric neurocritical care specialists and epileptologists—allowing doctors to make real-time medical decisions that can be lifesaving. Across the country, few centers have the capabilities or expertise for such integrated clinical care.
“Because the newborn brain is immature, EEG patterns look very different than what you would see in children or adults,” explains Dr. Ho, Medical Director of Neurocritical Care and Fetal-Neonatal Neurology in the Neurological Institute at CHLA, and the only fetal neurologist in Southern California. “That’s why continuous review by a pediatric‑trained team is so important—many quiet seizures can be missed without real‑time neonatal expertise.”
Cooling babies with mild HIE
Although therapeutic hypothermia is well established for newborns with moderate to severe hypoxic‑ischemic encephalopathy (HIE), CHLA also offers cooling therapy to newborns with mild encephalopathy. To better understand the impact of cooling therapy in this population, CHLA is one of 15 centers in the United States and Ireland participating in the COOL Prime study. The multicenter trial plans to enroll more than 400 infants and will compare neurodevelopmental outcomes between babies with mild HIE who receive cooling therapy and those who do not. The study is just one example of CHLA’s focus on research and multicenter trials aimed at improving neurodevelopmental outcomes for infants.
“Right now, we don’t have good evidence to support whether it’s better to cool babies with mild encephalopathy or not,” Dr. Jano notes. “The hope is that this study will help answer that question.”
Identifying cerebral palsy risk before discharge
Neurodevelopmental assessment in the NICU is also shifting earlier, allowing clinicians to identify infants at higher risk for cerebral palsy well before hospital discharge. At CHLA, select high‑risk newborns now undergo structured inpatient assessments—including the General Movements Assessment (GMA) and the Hammersmith Infant Neurological Examination (HINE)—as part of weekly neurodevelopmental rounds.
“These tools give us objective data earlier than we’ve traditionally had,” says Dr. Jano. “Rather than waiting for developmental concerns to emerge after discharge, we can begin to stratify risk and adjust care while the baby is still hospitalized.”
Neurocritical care that begins before birth
Through CHLA’s Fetal‑Maternal Center, teams provide advanced prenatal imaging such as fetal MRI and genetic testing to evaluate structural brain abnormalities, strokes, bleeds, and other conditions associated with adverse neurodevelopmental outcomes. The Center also offers specialized fetoscopic interventions—such as prenatal repair of myelomeningocele—aimed at reducing neurologic complications.
“Neurodevelopmental care doesn’t begin in the NICU,” says Dr. Ho. “For many of these infants, it begins prenatally, with early diagnosis and planning that allows us to coordinate care across specialties.”
Early identification can influence delivery planning and ensure that newborns with anticipated neurologic complexity are born at or transferred promptly to a center equipped for advanced neurocritical care.
A continuum of neurologic care
Long‑term follow‑up is essential to support neurodevelopment in infants identified as high risk, even years after they leave the NICU. At CHLA, these patients transition into the Newborn Follow-up Program, with access to Neurology, Developmental‑Behavioral Pediatrics, Rehabilitation Services, and other subspecialty care. For children with more complex neurologic needs, care may continue into later childhood and young adulthood.
“CHLA is one of the few centers in the country that can truly provide that kind of continuity—from prenatal diagnosis, through the NICU, and into childhood and even young adulthood,” says Dr. Ho. “We work across the hospital to support a child’s development every step of the way.”
Learn more about Fetal and Neonatal Neurocritical Care at CHLA.
About Children’s Hospital Los Angeles
Children’s Hospital Los Angeles is at the forefront of pediatric medicine and is the largest provider of hospital care for children in California. In the 125 years since its founding in 1901, CHLA has delivered a level of pediatric care that is among the best in the world. Ranked one of the top ten children’s hospitals in the nation by U.S. News & World Report, Children’s Hospital Los Angeles provides comprehensive and compassionate care to one of the largest and most diverse pediatric patient populations in the country. The hospital is the top-ranked children’s hospital in California and the Pacific U.S. region for 2025-26. A leader in pediatric research, CHLA is among the top ten children’s hospitals for research funding from the National Institutes of Health. The Saban Research Institute of Children’s Hospital Los Angeles supports the full continuum of research, translating scientific discoveries into life-changing treatments for patients around the globe. As a pediatric academic medical center, CHLA is also home to the Chuck Lorre Pediatric Health Education Institute, which encompasses education programs throughout the institution. The hospital’s commitment to building stronger, healthier communities is evident in CHLA’s efforts to enhance health education and literacy, introduce more people to careers in health care, and fight food insecurity. To learn more, follow CHLA on Facebook, Instagram, LinkedIn, YouTube, and X, and visit CHLA.org.
View source version on businesswire.com: https://www.businesswire.com/news/home/20260520026130/en/
Media gallery
