Utilization of Therapeutic Hypothermia and Neurological Injury in Neonates with Mild Hypoxic-Ischemic Encephalopathy: A Report from Children's Hospital Neonatal Consortium

Rakesh Rao; Ulrike Mietzsch; Robert DiGeronimo; Shannon E. Hamrick; Maria L. V. Dizon; Kyong-Soon Lee; Girija Natarajan; Toby D. Yanowitz; Eric S. Peeples; John Flibotte; Tai-Wei Wu; Isabella Zaniletti; Amit M. Mathur; An Massaro

doi:10.1055/s-0040-1716341

American Journal of Perinatology, Table of Contents

Am J Perinatol 2022; 39(03): 319-328
DOI: 10.1055/s-0040-1716341

Original Article

Utilization of Therapeutic Hypothermia and Neurological Injury in Neonates with Mild Hypoxic-Ischemic Encephalopathy: A Report from Children's Hospital Neonatal Consortium

Authors

Rakesh Rao

¹Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
Ulrike Mietzsch

²Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington
Robert DiGeronimo

²Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington
Shannon E. Hamrick

³Department of Pediatrics, Emory University, Atlanta, Georgia
Maria L. V. Dizon

⁴Department of Pediatrics, Northwestern University, Chicago, Illinois
Kyong-Soon Lee

⁵Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
Girija Natarajan

⁶Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
Toby D. Yanowitz

⁷Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Eric S. Peeples

⁸Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
John Flibotte

⁹Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Tai-Wei Wu

¹⁰Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
Isabella Zaniletti

¹¹Department of Pediatrics, Children's Hospitals Association, Kansas City, Kansas
Amit M. Mathur

¹²Department of Pediatrics, St. Louis University School of Medicine, St. Louis, Missouri
An Massaro

¹³Department of Pediatrics, Children's National Health Systems, Washington, Dist. of Columbia

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

Increasingly, neonates with mild HIE are being referred for consideration for hypothermia therapy.
Drift in clinical practice shows growing number of neonates treated with hypothermia as having mild HIE.
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 - EEG

Full Text

References

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