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Short-term outcomes after perinatal hypoxic ischemic encephalopathy: a report from the Children’s Hospitals Neonatal Consortium HIE focus group

Abstract

Objective:

To characterize infants affected with perinatal hypoxic ischemic encephalopathy (HIE) who were referred to regional neonatal intensive care units (NICUs) and their related short-term outcomes.

Study Design:

This is a descriptive study evaluating the data collected prospectively in the Children’s Hospital Neonatal Database, comprised of 27 regional NICUs within their associated children’s hospitals. A consecutive sample of 945 referred infants born 36 weeks’ gestation with perinatal HIE in the first 3 days of life over approximately 3 years (2010–July 2013) were included. Maternal and infant characteristics are described. Short-term outcomes were evaluated including medical comorbidities, mortality and status of survivors at discharge.

Result:

High relative frequencies of maternal predisposing conditions, cesarean and operative vaginal deliveries were observed. Low Apgar scores, profound metabolic acidosis, extensive resuscitation in the delivery room, clinical and electroencephalographic (EEG) seizures, abnormal EEG background and brain imaging directly correlated with the severity of HIE. Therapeutic hypothermia was provided to 85% of infants, 15% of whom were classified as having mild HIE. Electrographic seizures were observed in 26% of the infants. Rates of complications and morbidities were similar to those reported in prior clinical trials and overall mortality was 15%.

Conclusion:

Within this large contemporary cohort of newborns with perinatal HIE, the application of therapeutic hypothermia and associated neurodiagnostic studies appear to have expanded relative to reported clinical trials. Although seizure incidence and mortality were lower compared with those reported in the trials, it is unclear whether this represented improved outcomes or therapeutic drift with the treatment of milder disease.

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Acknowledgements

JMA, DJD, FD, JRE (Chair), KMR, MAP, EKP, KMR and BLS are members of the Children’s Hospital Neonatal Consortium. The CHNC (http://www.thechnc.org) has partnered with the Children’s Hospital Association, Inc. (CHA; Overland Park, KS, USA) in order to design, launch and maintain the CHND. We are indebted to the following institutions that serve infants and their families, and these institutions also have invested in and continue to participate in the CHND. For more information about CHND, please contact Kate Conrad, Vice President (chnd@childrenshospitals.org). We also thank the site sponsors for the CHND for their investments in this program. The site sponsors are Children's Healthcare of Atlanta, Atlanta, GA, USA (Francine Dykes, Anthony Piazza); Children’s Healthcare of Atlanta at Scottish Rite (Gregory Sysyn); Children's Hospital of Alabama, Birmingham, AL, USA (Carl Coghill); Le Bonheur Children's Hospital, Memphis, TN, USA (Ramasubbareddy Dhanireddy); Children's Hospital Boston, Boston, MA, USA (Anne Hansen); Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA (Karna Murthy); Nationwide Children's Hospital, Columbus, OH, USA (Kristina Reber); Children's Medical Center Dallas, Dallas, TX, USA (Rashmin Savani); Children's Hospital Colorado, Aurora, CO, USA (Theresa Grover); Children’s Hospital of Michigan, Detroit, MI, USA (Girija Natarajan); Cook Children's Health Care System, Fort Worth, TX, USA (Jonathan Nedrelow, Annie Chi); Texas Children's Hospital, Houston, TX, USA (Stephen Welty); Children's Mercy Hospitals & Clinics, Kansas City, MO, USA (Eugenia Pallotto); Arkansas Children's Hospital, Little Rock, AR, USA (Becky Rodgers, Robert Lyle); Children’s Hospital Los Angeles, Los Angeles, CA, USA (Lisa Kelly (deceased), Steven Chin); UCSF Benioff Children's Hospital, Oakland, CA, USA (David Durand, Jeanette Asselin, Priscilla Joe); The Children's Hospital of Philadelphia, Philadelphia, PA, USA (Jacquelyn Evans, Michael Padula); Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA (Beverly Brozanski); St Louis Children's Hospital, St Louis, MO, USA (Joan Rosenbaum, Tasmin Najaf, Amit Mathur, Rakesh Rao); All Children's Hospital, St Petersburg, FL, USA (Victor McKay); Rady Children's Hospital, San Diego, CA, USA (Mark Speziale); Children's National Medical Center, Washington, DC, USA (Billie Short); A.I. duPont Hospital for Children, Wilmington, DE, USA (Kevin Sullivan); Primary Children’s Medical Center, Salt Lake City, UT, USA (Donald Null, Robert Di Geronimo); Children’s Hospital of Wisconsin, Milwaukee, WI, USA (Michael Uhing); Children’s Hospital of Omaha, Omaha, NE (Lynne Willett, John Grebe); Florida Hospital for Children, Orlando, FL (Rajan Wadhawan), Seattle Children’s, Seattle, WA (Elizabeth Jacobson Misbe).

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Correspondence to A N Massaro.

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Competing interests

KM received a portion of salary support from the Children’s Hospital Association (CHA) in 2012. IZ is an employee of CHA. JMA received a portion of salary support from CHA in 2011–2013 for the development and maintenance of the database that was analyzed for this study. JRE received a stipend from CHA in 2012. The remanining authors declare no conflict of interest.

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Massaro, A., Murthy, K., Zaniletti, I. et al. Short-term outcomes after perinatal hypoxic ischemic encephalopathy: a report from the Children’s Hospitals Neonatal Consortium HIE focus group. J Perinatol 35, 290–296 (2015). https://doi.org/10.1038/jp.2014.190

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