Hypoxic ischemic encephalopathy (HIE) impacts 1 to 3 in 1000 live births in the United States and is a common cause of neonatal morbidity and mortality.1 The incidence of HIE has increased slightly over the last 10 years in term infants, but mortality has decreased, likely due to the increased use of therapeutic hypothermia and the advent of neuro neonatal intensive care units (NICU) which provide focused care for these infants. Despite these lifesaving advancements, persistent disparities exist in outcomes. In the United States, Black infants are less likely than white infants to receive therapeutic hypothermia, and when they do receive it, are more likely to have a hospital readmission, a tracheostomy, and later be diagnosed with cerebral palsy.2 These disparities are consistent with poorer maternal health outcomes overall experienced by Black birthing people and their infants due to structural racism and concentrated poverty,3 leading to disparities in healthcare access (including specialized care) and bias and medical racism within the healthcare system.4,5,6 There is an urgent need to advance policy solutions to reduce disparities in HIE, equitably implement therapeutic hypothermia, and ensure thriving for infants with HIE and their families.

This month’s article by Bansal et al.7 provides important guidance on strategies to reduce inequities in HIE by ensuring families are partners in the neuro NICU. They highlight several evidence-based recommendations including skin-to-skin contact, parent-focused communication, use of inviting language, and single-family rooms. They note the importance of having multiple members of the neuro NICU team who are available to provide holistic support to families. Importantly, the article also discusses disparities observed in this population including in level of parental presence at the bedside and parental participation in newborn care. These observations require that we address the fact that traditional healthcare spaces are not consistently trustworthy partners for many people served. One important strategy to consider is the use of doula support for families whose infants are in the neuro NICU. Doulas are trained professionals who provide emotional, physical, and informational support during pregnancy, delivery, and the post-partum period, with a specific focus on centering the needs of Black, Indigenous, People of Color, and other marginalized communities.8 Doulas are an evidence-based solution to improve neonatal outcomes more broadly. Studies evaluating the outcomes of doula programs have demonstrated higher rates of vaginal births,9,10,11 breastfeeding,11,12 term births,10,11,13, and satisfaction with birthing experiences14 compared with people who did not receive doula care. Doulas also buffer the individual and structural-level racism and other forms of oppression that show up in the healthcare setting.15,16 Doula care is endorsed by the American College of Obstetricians and Gynecologists17 and may be hospital or community-based.

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