160 - Short term outcomes of infants with acidotic cord gas with benign neurological exam at birth

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 160
Publication Number: 160.136

Ana G. Alvarez Pagan, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Hackensack, NJ, United States; Juhi Motiani, Hackensack University Medical Center, Yardleu, PA, United States; Catherine L. Hahn, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Westwood, NJ, United States; Tara Lozy, Hackensack Meridian School of Medicine, Hackensack, NJ, United States; Ariel Sherbany, Hackensack Meridian School of Medicine, Hackensack, NJ, United States; Rakesh Chhabra, Hackensack Meridian School of Medicine, Hackensack, NJ, United States; Marwa Khalil, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Hackensack, NJ, United States

Presenting Author(s)

Ana G. Alvarez Pagan, MD, MHA, FAAP (she/her/hers)

Neonatal Perinatal Fellow
Joseph M. Sanzari Children's Hospital Hackensack University Medical Center
Hackensack, New Jersey, United States

Background: Recent studies have shown an increased risk of mortality, brain injury, seizures and NDI in infants with mild HIE. In early hours after a significant hypoxic ischemic event, majority of newborns do not demonstrate clear signs of brain compromise yet these abnormalities may develop in the ensuing hours to days after birth.

Objective:
Identify the gap in our current clinical practice by investigating short term outcomes among newborns >35 weeks born with significant metabolic acidosis but did not meet therapeutic hypothermia(TH) criteria.

Design/Methods: Single center retrospective chart review of newborns from Jan.2018 to Mar.2021 with cord gas pH < 7.0 and/or base excess ≥12 mmol/L born at HUMC. Those with birth anomalies, birth weight< 1800g,or met TH criteria were excluded. Summary statistics include mean with standard deviation and counts with associated frequencies. Group comparisons were performed using Student t-test, with a significance threshold at 0.05.

Results: Initial sample size was 184.18 received TH. Final n=166. 28% had initial pH< 7 and BE ≥12. 24% had initial pH< 7 (Mean7.07, SD 0.10).89% had a BE≥ 12 (Mean 14.2, SD 2.1).48%(79) delivered vaginally, 52%(87) via C Section. Those born via C Section had a significantly lower pH than those delivered vaginally(7.04 vs 7.1p=0.0008).Total of 42 infants had a sentinel event (Cat III tracing, shoulder dystocia, placental abruption, uterine rupture or cord prolapse). Having a sentinel event was not associated with a lower pH 7.05 vs. 7.08(p= 0.1315).There was no association between having low Apgar scores and having a low pH.60%(99) were admitted to the NICU and 40%(67) to the WBN. 80/99(81%) of admissions to the NICU were due to respiratory distress, of which 2/80 developed seizures at 9 and 14 hours of life. 6%(6/99) for possible sepsis, 13%(13/99) for closer monitoring.16%(11/67) of patients in WBN were transferred to NICU. 8/11(72%) had hypoglycemia, one associated with AKI on admission.1/11(9%) had respiratory distress,1/11(9%) had temperature instability, and 1/11(9%) had bloody stools.

Conclusion(s):
Infants retrospectively identified with severe acidosis at birth who didn't meet TH criteria on admission, were at higher risk for admission or transfer to NICU. Findings during admission included hypoglycemia, respiratory distress, temperature instability, AKI, and seizures.These outcomes may represent the effects of possible perinatal hypoxia-ischemia. Therefore, this population may benefit from close monitoring in NICU settings to further detect possibly missed mild HIE cases.Larger scale studies are required to confirm these findings.