Prevalence of Hypoxic Ischemic Encephalopathy and Multiorgan Dysfunction in Late Preterm and Term Infants Receiving Resuscitation Beyond Initial Steps at Birth

TL;DR

This study finds that brain injury and organ failure are common in late preterm and term infants needing extended resuscitation at birth, with severe brain injury linked to higher mortality.

Contribution

The study provides new insights into the prevalence and severity of hypoxic-ischemic encephalopathy and multiorgan dysfunction in resuscitated late preterm and term infants.

Findings

40% of resuscitated infants developed hypoxic-ischemic encephalopathy, with Stage III being most common.

Metabolic and renal dysfunction were the most prevalent types of multiorgan dysfunction.

Mortality was highest among infants with cardiovascular dysfunction and severe brain injury.

Abstract

Background and objective: Perinatal asphyxia is a leading cause of neonatal morbidity and mortality, frequently resulting in hypoxic-ischemic encephalopathy (HIE) and multiorgan dysfunction (MOD). During asphyxia, the “diving reflex” preferentially redistributes blood flow to vital organs, predisposing other organ systems to ischemic injury. Data on the burden and pattern of MOD among resuscitated late preterm and term neonates remain limited. The primary objective of this study was to determine the frequency and severity of HIE in late preterm and term neonates requiring resuscitation beyond the initial steps at birth. The secondary objectives were to evaluate the prevalence and pattern of MOD in these infants and to assess the association between HIE severity, organ dysfunction, and mortality.

Materials and methods: A prospective observational study was conducted over one year in the neonatal unit and neonatal intensive care unit (NICU) of a tertiary-care hospital, King George’s Medical University (KGMU), Lucknow, India. A total of 164 neonates (≥34 weeks’ gestation) who required resuscitation beyond initial steps were enrolled after obtaining informed parental consent. Demographic, perinatal, and clinical data were recorded. Organ dysfunction was evaluated using clinical and biochemical criteria for the central nervous, cardiovascular, renal, hepatic, respiratory, hematologic, and metabolic systems. The severity of HIE was graded using Sarnat and Sarnat staging. Statistical analysis was performed using IBM SPSS Statistics software, version 26 (IBM Corp., Armonk, NY, USA), with p <0.05 considered significant.

Results: Among 164 neonates requiring resuscitation, 40% (66/164) developed HIE, with Stage III being most common (51.5%). MOD was frequent, with metabolic derangements (81.1%) and renal (55.5%) being the most prevalent. Overall mortality was 20.7% (34/164), highest among neonates with cardiovascular dysfunction (54.9%) and HIE III (79.4%). The intensity of resuscitation correlated with organ involvement: prolonged positive pressure ventilation (PPV) >1 min, intubation, chest compressions, and drug use were significantly associated with higher rates of central nervous system (CNS), cardiovascular, renal, respiratory, hematological, gastrointestinal, and metabolic dysfunction (p<0.05).

Conclusion: HIE and MOD are common in late preterm and term neonates requiring resuscitation beyond initial steps, with the severity of HIE closely linked to the extent of organ involvement and mortality. Early recognition and close monitoring of MOD are essential to improve outcomes in this high-risk population.

Figures