187 - Clinical predictors of death and long-term neurological outcomes in infants with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.

Neonatal encephalopathy as a result of perinatal hypoxia-ischemia (Hypoxic-Ischemic Encephalopathy, HIE) is a significant cause of neonatal mortality worldwide. Therapeutic Hypothermia (TH) is standard of care in the developed world, and the outcomes of HIE need to be redefined in the setting of treatment with TH.

Objective:

To review the evolving epidemiology of HIE at a tertiary care NICU with the goal of identifying clinical predictors of long-term neurological outcomes in infants with HIE.

Design/Methods:

A retrospective chart review was conducted of neonates with HIE and admitted to the NICU at Children’s Hospital of the King’s Daughters in Norfolk, VA from 2012-2022. NICU course and outcome data were collected. Neurodevelopmental scores using the Capute scale were assessed multiple times between 6-36 months. Primary outcome of survival without neurological abnormality (SWNA) was created to include infants with HIE who survived without complications of cerebral palsy, tracheostomy/ventilator dependence, G-tube dependence, seizures/epilepsy, visual impairment or sensorineural hearing loss. Chi-square, Mann-Whitney and T-tests were used to assess association between variables. Logistic regression was used to assess the association between SWNA and time to full oral feeds. SPSS.28 (Chicago, IL) was used to analyze data.

Results:

217 patients with a diagnosis of HIE were admitted to the NICU from 2012-2021. The likelihood of death was significantly higher among infants requiring chest compressions in the delivery room (p=0.005), infants with hyperglycemia requiring insulin (p< 0.001), and infants with renal failure (p< 0.001). The odds of SWNA were 2.5 times higher among those with normal MRI when compared to those with evidence of hypoxic injury on brain MRI [OR=2.46, 95% CI (1.28, 4.74), p=006]. The odds of SWNA decreased with increasing time needed to achieve full oral feeds [OR=0.95, 95% CI (0.91, 0.98), p=0.004], after controlling for gestational age. Median time to achieve full feeds was 8 days (25^th-75^th percentile, 7-12) for the SWNA group when compared to infants with neurological abnormalities [Median 10.5 days (8-22)], p=0.01.

Conclusion(s):

In this preliminary analysis of infants with HIE from a single-center, MRI abnormalities and time to achieve full oral feeds were important predictors of long-term neurological outcomes. Need for chest compressions, insulin for hyperglycemia, and renal failure were important predictors of death. Final analysis will include logistic regression modeling to measure the individual contribution of risk factors to capute neurodevelopmental scores in survivors.