Short-Term Outcomes of Newborns with Perinatal Acidemia Who are Not Eligible for Systemic Hypothermia Therapy

Abstract

Objective To determine short-term outcomes of infants who had perinatal acidemia and were evaluated for hypothermia therapy but did not qualify based on a standardized neurologic examination. Study design Retrospective, single-site cohort study of inborn infants of ≥36 weeks gestation who had perinatal acidemia from October 2005-September 2008 and had a standardized neurologic examination performed by a certified neonatologist to assess eligibility for hypothermia therapy. An abnormal short-term nursery outcome was defined as death, seizures, brain magnetic resonance imaging consistent with hypoxic-ischemic encephalopathy, abnormal neurologic examination at discharge, gastrostomy tube feeding, or inability to nipple all feeds beyond the first week of age. Results One hundred forty-four (0.3%) of 46 887 newborns with perinatal acidemia had a neurologic examination performed that was either normal (n = 29) or consistent with mild encephalopathy (1 or 2 abnormal categories; n = 60). Of the latter infants classified as having mild encephalopathy, 12 (20%) experienced an abnormal short-term outcome (feeding difficulties, n = 8; abnormal neurologic examination at discharge, n = 7; abnormal brain magnetic resonance imaging, n = 6; seizures, n = 5; gastrostomy, n = 1; or death, n = 1). Conclusions Twenty percent of newborns with perinatal acidemia and a neurologic examination that revealed only mild encephalopathy had abnormal short-term outcomes that could be attributed to the encephalopathy. Adjunctive tools or biomarkers for optimal assessment of infants with fetal acidemia for hypothermia therapy are needed.

Biomarkers for Severity of Neonatal Hypoxic-Ischemic Encephalopathy and Outcomes in Newborns Receiving Hypothermia Therapy

“…This group of neonates with mild HIE are poorly characterized, and recent evidence suggests that up to 20% can have abnormal short-term outcomes. 47 Unfortunately, data on multiple organ injury (eg, creatinine, liver enzymes) in these neonates with mild HIE were not evaluated. Findings in the neonates with encephalopathy support the search for biomarkers in addition to the neurological examination to better stratify subgroups that might benefit from neuroprotective therapies.…”

Hypothermia Therapy for Neonatal Hypoxic Ischemic Encephalopathy in the State of California

“…A study by DuPont et al found that 20% of infants with perinatal acidemia and a neurologic examination revealing only mild encephalopathy had abnormal short-term outcomes including feeding difficulties, abnormal MRI, seizures, abnormal neurologic exam at discharge or death. 19 An ongoing observational study may provide further information regarding the natural history and outcomes of children with mild HIE (NCT01747863).…”

Heart rate variability in hypoxic ischemic encephalopathy: correlation with EEG grade and 2-y neurodevelopmental outcome

“…We have shown that HRV is negatively associated with EEG grade of HIE severity and demonstrated significant differences in HRV between mild and moderate EEG grades and also between mild and severe grades. This is an important finding as it is sometimes difficult to distinguish between mild and moderate grades of encephalopathy using currently available clinical markers (13). Neonates with severe HIE, on the other hand, are generally easier to identify clinically.…”