Resident Joseph M. Sanzari Children's Hospital Hackensack University Medical Center Hackensack, New Jersey, United States
Background: It is known that neonatal neurological status can evolve rapidly and progress from no or mild encephalopathy to more severe manifestations in the first hours to days after birth. Recent data in untreated infants with “mild” HIE show a higher range of abnormal neurologic outcomes through school age. Objective: Investigate the outcome among newborns > 35 weeks born over 10 years with significant metabolic acidosis who did not meet therapeutic hypothermia (TH) criteria. Design/Methods: Single-center retrospective chart review of newborns from Jan. 2013 to June 2022 with cord gas pH < 7.0 and/or base excess ≥ 12 mmol/L born at a tertiary center. We excluded babies with birth anomalies, birth weight < 1800g, if they met TH criteria or required transfer or expired. Summary statistics were used to describe outcomes. Results: In this 10-year cohort, n=484 from 61,932 live births were identified with perinatal acidemia. 54 were excluded. 430 infants met our inclusion criteria. The mean pH was 7.06 (SD - 0.11) and the median for BD was -14.1 (IQR-15.3 to -12.3). Of these 248 (57.7%) were admitted to the NICU and 182 (42.3%) were admitted to the well-baby nursery (WBN). 78% (194/248) of admissions to the NICU were due to respiratory distress. Of those admitted initially to the WBN, 14.3% (26/182) required transfer to the NICU. 7/26 (27%) had hypoglycemia,6/26 (23%) had respiratory distress, 1/26 developed seizures. 9 patients had failed hearing tests at discharge. Access to long term outcomes was limited in our cohort; they included speech delay in 4, attention deficit hyperactivity disorder (ADHD) in 2, and autism spectrum disorder (ASD) in 2.
Conclusion(s): Infants who experience perinatal acidosis at birth but do not meet the criteria for therapeutic hypothermia are at an increased risk of being admitted to the NICU. These infants may experience short-term outcomes such as hypoglycemia, respiratory distress, and seizures, which may be signs of perinatal hypoxia-ischemia. It is worth noting that this cohort had adverse long-term neurodevelopmental outcomes. Therefore, it would be beneficial to monitor this population closely for signs of mild encephalopathy in an intensive care setting. Additionally, long-term follow-up could prove to be useful for patients, including neurodevelopmental assessments and services such as early intervention programs (EIP) if required. Further studies are necessary to address these findings.
