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Am J Perinatol 2022; 39(03): 319-328
DOI: 10.1055/s-0040-1716341
Original Article

Utilization of Therapeutic Hypothermia and Neurological Injury in Neonates with Mild Hypoxic-Ischemic Encephalopathy: A Report from Children's Hospital Neonatal Consortium

Rakesh Rao 
1   Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
,
Ulrike Mietzsch
2   Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington
,
Robert DiGeronimo
2   Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington
,
Shannon E. Hamrick
3   Department of Pediatrics, Emory University, Atlanta, Georgia
,
Maria L. V. Dizon
4   Department of Pediatrics, Northwestern University, Chicago, Illinois
,
Kyong-Soon Lee
5   Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
,
Girija Natarajan
6   Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
,
Toby D. Yanowitz
7   Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Eric S. Peeples
8   Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
,
John Flibotte
9   Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
,
Tai-Wei Wu
10   Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
,
Isabella Zaniletti
11   Department of Pediatrics, Children's Hospitals Association, Kansas City, Kansas
,
Amit M. Mathur
12   Department of Pediatrics, St. Louis University School of Medicine, St. Louis, Missouri
,
An Massaro
13   Department of Pediatrics, Children's National Health Systems, Washington, Dist. of Columbia
› Author Affiliations Funding None.
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Abstract

Objective This study was aimed to describe utilization of therapeutic hypothermia (TH) in neonates presenting with mild hypoxic-ischemic encephalopathy (HIE) and associated neurological injury on magnetic resonance imaging (MRI) scans in these infants.

Study Design Neonates ≥ 36 weeks' gestation with mild HIE and available MRI scans were identified. Mild HIE status was assigned to hyper alert infants with an exaggerated response to arousal and mild HIE as the highest grade of encephalopathy recorded. MRI scans were dichotomized as “injury” versus “no injury.”

Results A total of 94.5% (257/272) neonates with mild HIE, referred for evaluation, received TH. MRI injury occurred in 38.2% (104/272) neonates and affected predominantly the white matter (49.0%, n = 51). Injury to the deep nuclear gray matter was identified in (10.1%) 20 infants, and to the cortex in 13.4% (n = 14 infants). In regression analyses (odds ratio [OR]; 95% confidence interval [CI]), history of fetal distress (OR = 0.52; 95% CI: 0.28–0.99) and delivery by caesarian section (OR = 0.54; 95% CI: 0.31–0.92) were associated with lower odds, whereas medical comorbidities during and after cooling were associated with higher odds of brain injury (OR = 2.31; 95% CI: 1.37–3.89).

Conclusion Majority of neonates with mild HIE referred for evaluation are being treated with TH. Odds of neurological injury are over two-fold higher in those with comorbidities during and after cooling. Brain injury predominantly involved the white matter.

Key Points

  • Increasingly, neonates with mild HIE are being referred for consideration for hypothermia therapy.

  • Drift in clinical practice shows growing number of neonates treated with hypothermia as having mild HIE.

  • MRI data show that 38% of neonates with mild HIE have brain injury, predominantly in the white matter.

Keywords

therapeutic hypothermia - white matter injury - mild hypoxic-ischemic encephalopathy - MRI - EEG

Authors' Contribution

R.R., U.M., R.D., K.S.L., T.D.Y., M.L.V.D., S.E.H., G.N., E.S.P., J.F., T.W.W., A.M.M., and A.M. made substantial contributions to conception and design of the study and interpretation of data. R.R. prepared the first and final draft of the article and revised it critically for important intellectual content. U.M. and R.D. made substantial contributions in the preparation of the initial draft, and revised it critically for important intellectual content. I.Z. made substantial contributions to the analysis and interpretation of data; revised the article critically for important intellectual content. K.S.L., T.D.Y., M.L.V.D., S.E.H., G.N., E.S.P., J.F., T.W.W., A.M.M., and A.M. revised the article critically for important intellectual content. All authors approved the final manuscript as submitted and accountable for all aspects of the work.


Note

Data in the manuscript were presented in part (abstract) at the Pediatric Academic Societies meeting in Baltimore, MD, on April 29, 2019.




Publication History

Received: 21 April 2020

Accepted: 23 July 2020

Article published online:
06 September 2020

© 2020. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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