Maternal and neonatal exposure to risk factors for neonates with moderate or severe hypoxic ischemic encephalopathy: a cross-sectional study

Abstract

Background To investigate the association between maternal and neonatal exposure to the relevant influencing factors and risk of moderate or severe hypoxic ischemic encephalopathy (HIE), and the possible interactions in the Chinese population. Methods A cross-sectional study comprising 228 neonates from Henan Children’s Hospital during the five-year period 2015–2020 in China was conducted. All neonatal basic demographic information and clinical records were documented from the neonatal HIE database. Comparisons between mild HIE and moderate or severe HIE were conducted with the t-test or Wilcoxon rank-sum test for continuous variables and the Chi-square test for categorical variables. Unconditional multiple logistic regression models were used to generate the odds ratios(ORs) and 95% confidence intervals(CIs). In addition, we also used an additive model to test for possible biological interactions among the factors. Results Of the 228 neonates, the males had a statistically significantly higher frequency compared with the females between the two groups (P = 0.030). Trend analysis results found that with the decreased of the neonatal birth weight, the detection rates of moderate or severe HIE in males and females were gradually increased (Ptrend < 0.05). The detection of moderate or severe HIE in males and females increased with the decreased of neonatal gestational age at birth(Ptrend < 0.05). However, no interaction was detected between neonatal birth weight and gestational age at birth based on the additive model, the Relative Excess Risk of Interaction and 95% CI was 0.821(-0.046,1.687). The adjusted multiple logistic regression model showed that low birth weight(ORadj:1.965, 95%CI:1.086–4.127),premature infant(ORadj:1.557, 95%CI:1.589–4.862),1-min Apgar’s score < 7(ORadj:5.618, 95%CI:3.724–7.353),intrauterine distress(ORadj:4.916, 95%CI:3.431–7.398),amniotic fluid contamination (ORadj:3.965, 95%CI:2.153–5.782) significantly increased the risk of neonatal moderate or severe HIE. Conclusion Neonates with low birth weight, premature infant,1-min Apgar’s score < 7, intrauterine distress, amniotic fluid contamination are risk factors for moderate or severe HIE. Notably, we found no biological interaction between risk factors based on the additive model, these findings may help to inform prevention strategies, as this may effectively reduce the incidence of neonatal moderate or severe HIE.

Maternal and Fetal Risk Factors for Neonatal Hypoxic-Ischemic Encephalopathy: A Retrospective Study

“…17,18 Low birth weight significantly increased the risk of neonatal moderate or severe HIE. 19 Birth weight less than 3.0kg or greater than 4.0kg is a risk factor for moderate-to-severe neonatal HIE. 20 In the present study, low birth weight was an independent risk factor for HIE.…”

“…Amniotic fluid contamination significantly increased the risk of neonatal moderate or severe HIE. 19 Meconium stained liquor is a major risk factor for birth asphyxia, so amniotic fluid contamination is also one of the risk factors for HIE. 23 Our results are consistent with the results of these researches.…”

“…14 1-min Apgar score <7 significantly increased the risk of neonatal moderate or severe HIE. 19 The Apgar score is the most commonly used score to quantify the postnatal state of the newborn, especially after fetal asphyxia. 25 In one study, a cohort of infants with perinatal asphyxia was analyzed based on machine learning methods to construct a predictive risk model for HIE, incorporating clinical indicators including Apgar score.…”

Correlation analysis between the amniotic fluid contamination and clinical grading of neonatal hypoxic–ischemic encephalopathy and biomarkers of brain damage

“…According to relevant report on neonates with hypoxic brain injury, approximately 80% of cases occur in the prenatal period and 10–20% of cases occur in the perinatal period [ 29 ]. Many risk factors are associated with neonatal HIE, such as AFC [ 4 , 5 , 30 – 34 ], low birth weight (< 2.5 kg) [ 33 ], gestation age ≥ 41 weeks, umbilical cord around neck [ 35 ], newborn born to women without reproductive history [ 5 ], placental abruption, ruptured uterus [ 31 ], placenta previa, dystocia, fetal respiratory distress syndrome, emergency cesarean Sects. [ 4 , 36 ], growth retardation, large head circumference [ 30 ], chorioamnionitis [ 36 ], Apgar score [ 31 ], and so on.…”

The association between plasma IgG N-glycosylation and neonatal hypoxic–ischemic encephalopathy: a case-control study

“…HIE accounts for about 15–35% of all cases of brain damage in late-preterm neonates and disorders in late-preterm and term neonates and is associated with the potential for long-term complications, including epilepsy, motor impairment, and cognitive impairment ( Wang et al, 2022 ). The pathological process of HIE includes three stages: early injury, intermediate stage, and reperfusion injury ( Rasineni et al, 2022 ).…”