7 pixels (1.5*5 frames -0.5px) for 1 hp isn't good for the current route. Since we already end the level (5-1, 5-2, 5-3) with 1 hp, we would need to replace it with another boost that would be fewer position sacrifice, and there isn't anywhere.
The closest (in pixel saves) 1hp boost would be the 5-3 1st screen tyson boost but it's still better to use it.
edit: the bird boost we do in 5-1 takes 3 dmg but saves 54 frames, but I don't see any place where we could spend 2 more HP to get that many frames (if we would use this and ignore the birdy boost)
I was sure that this required too much delay to help a TAS, but it turns out the all it needed was the one-frame pause to adjust the spawn and a ysub > 0x43 (which rules out slots 6 and 7 since the stage 4 boss so inconsiderately zeroes those values). Anyway, it puts any% 6.5px ahead. Not sure yet how the rest of the run will be affected or which boost it will have to replace. Optimistically it should allow a final frame count under 39100 and over one full second improvement over the published run.
Hey, why is it a 7px diff in pacifist? Too lazy to check myself right now.
I've tried to incorporate it into pacifist route with:
doing the RTA trick at 5-1 start
boost from knife bitch's knife instead of the birdy boost
This way I'm 2 frames behind but have an extra HP, however the bat at 5-1 is at terribly bad place (because the bird wants to hit us too). Even if I could continue it (with minimal sacrifice), there's no other place to spend 1 extra hp. But glad that it has impact for any% :)