11 - Hypoxic-Ischemic Encephalopathy: A Longitudinal Cohort Study Assessing Multiple Organ Involvement

Poster Number: 11
Publication Number: 11.335

Background: Hypoxic ischemic encephalopathy (HIE) potentially affects multiple organs including the brain, heart, liver, and kidneys, which can lead to long-term complications. To date, few studies have evaluated the presence of multi-organ dysfunction (MOD) in neonates with mild HIE.

Objective: To evaluate the incidence of MOD in neonates with mild, moderate, and severe HIE; and to determine the correlation between the HIE severity and the degree of organ involvement.

Design/Methods: In this retrospective cohort study, we included neonates with HIE admitted to the intensive care unit at Parkland Memorial hospital, between 2009-2023. Our cohort was divided into two groups based on Sarnat staging: one for newborns with mild HIE and the other for newborns with moderate to severe HIE who received therapeutic hypothermia. To assess MOD, we evaluated cardiac function using echocardiography and troponin T, renal function using creatinine and blood urea nitrogen (BUN), liver function using alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Markers of MOD were collected on days 1 and 3 after birth.

Results: We included 506 neonates: 238 with mild HIE, and 268 with moderate to severe HIE (Table 1). Among the whole cohort, 46% had cardiac injury, 34% had kidney injury, and 29% had liver injury. In the mild HIE group 33% exhibited MRI abnormalities, while the moderate to severe group had a significantly higher rate (69%; p=0.04). The number of organs involved was also higher in the moderate to severe group (38% vs. 27%; p=0.010). Notably, the rates of kidney (35% vs. 33%; p=0.631) and liver injury (30% vs. 28%; p=0.606) were comparable between the two groups while neonates with moderate to severe HIE showed a significantly higher incidence of cardiac injury compared to those with mild HIE (65% vs. 26%; p< 0.001). The Sarnat Score plotted in Figure 1 demonstrated a statistically significant, yet weak correlation with liver and cardiac biomarkers reflecting the extent of MOD severity in HIE.

Conclusion(s): This study highlights the high risk of MOD among neonates with mild HIE despite their lower degree of encephalopathy. It emphasizes the importance of close monitoring of MOD-related biomarkers in neonates, regardless of their HIE severity.