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DOI: 10.1055/s-0040-1716341
Utilization of Therapeutic Hypothermia and Neurological Injury in Neonates with Mild Hypoxic-Ischemic Encephalopathy: A Report from Children's Hospital Neonatal Consortium
Funding None.
Abstract
Objective This study was aimed to describe utilization of therapeutic hypothermia (TH) in neonates presenting with mild hypoxic-ischemic encephalopathy (HIE) and associated neurological injury on magnetic resonance imaging (MRI) scans in these infants.
Study Design Neonates ≥ 36 weeks' gestation with mild HIE and available MRI scans were identified. Mild HIE status was assigned to hyper alert infants with an exaggerated response to arousal and mild HIE as the highest grade of encephalopathy recorded. MRI scans were dichotomized as “injury” versus “no injury.”
Results A total of 94.5% (257/272) neonates with mild HIE, referred for evaluation, received TH. MRI injury occurred in 38.2% (104/272) neonates and affected predominantly the white matter (49.0%, n = 51). Injury to the deep nuclear gray matter was identified in (10.1%) 20 infants, and to the cortex in 13.4% (n = 14 infants). In regression analyses (odds ratio [OR]; 95% confidence interval [CI]), history of fetal distress (OR = 0.52; 95% CI: 0.28–0.99) and delivery by caesarian section (OR = 0.54; 95% CI: 0.31–0.92) were associated with lower odds, whereas medical comorbidities during and after cooling were associated with higher odds of brain injury (OR = 2.31; 95% CI: 1.37–3.89).
Conclusion Majority of neonates with mild HIE referred for evaluation are being treated with TH. Odds of neurological injury are over two-fold higher in those with comorbidities during and after cooling. Brain injury predominantly involved the white matter.
Key Points
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Increasingly, neonates with mild HIE are being referred for consideration for hypothermia therapy.
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Drift in clinical practice shows growing number of neonates treated with hypothermia as having mild HIE.
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MRI data show that 38% of neonates with mild HIE have brain injury, predominantly in the white matter.
Keywords
therapeutic hypothermia - white matter injury - mild hypoxic-ischemic encephalopathy - MRI - EEGAuthors' Contribution
R.R., U.M., R.D., K.S.L., T.D.Y., M.L.V.D., S.E.H., G.N., E.S.P., J.F., T.W.W., A.M.M., and A.M. made substantial contributions to conception and design of the study and interpretation of data. R.R. prepared the first and final draft of the article and revised it critically for important intellectual content. U.M. and R.D. made substantial contributions in the preparation of the initial draft, and revised it critically for important intellectual content. I.Z. made substantial contributions to the analysis and interpretation of data; revised the article critically for important intellectual content. K.S.L., T.D.Y., M.L.V.D., S.E.H., G.N., E.S.P., J.F., T.W.W., A.M.M., and A.M. revised the article critically for important intellectual content. All authors approved the final manuscript as submitted and accountable for all aspects of the work.
Note
Data in the manuscript were presented in part (abstract) at the Pediatric Academic Societies meeting in Baltimore, MD, on April 29, 2019.
Publication History
Received: 21 April 2020
Accepted: 23 July 2020
Article published online:
06 September 2020
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