Fellow Loma Linda University Children's Hospital Loma linda, California, United States
Background: Despite therapeutic hypothermia, hypoxic ischemic encephalopathy (HIE) continues to be a complex disease associated with significant morbidity and mortality. The estimated mortality rate is 15-25% with 40-50% of survivors having long term adverse neurological sequelae. Current studies to determine the prognosis of HIE have used EEG and MRI findings, but there is little published information on the predictive value of these diagnostic tools when focusing specifically on babies with moderate HIE (Sarnat II). Identifying better prognostic outcome indicators for moderate HIE remains challenging, needing further exploration. Objective: (1) to determine which maternal, neonatal, neurologic and neuroimaging factors contribute the most to predicting adverse events in all HIE categories, (2) to identify those factor(s) that most strongly predict adverse events specifically in moderate HIE and (3) to develop a risk scale that could suggest the need for early interventions to minimize harm. Design/Methods: Neonates born with HIE at Loma Linda University Children’s Hospital (LLUCH) and those who were transported to LLUCH for therapeutic hypothermia between 01/01/2020–12/31/2022 were identified. Infants with genetic abnormalities, fetal anomalies, abnormal metabolic work up, and/or congenital heart disease or those with poor documentation from an outside hospital were excluded. Retrospective chart review will collect maternal, neonatal and neurologic risk factors used to characterize HIE and determine severity of illness. EEG findings and brain MRI/MRS biomarkers for hypoxic brain injury will be reviewed. Serious morbidities including need for tracheostomy and/or gastrostomy tube at time of discharge will be recorded. Neurodevelopmental outcome data will be documented at 3–4 months, 12 months and 18–36 months CGA. Factor analysis will condense large numbers of variables into clusters of correlated factors to identify patterns of clinical and imaging variables that are associated with and predict adverse outcomes in all categories of HIE and specifically moderate HIE.
