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Association between multi-organ dysfunction and adverse outcome in infants with hypoxic ischemic encephalopathy

Journal of Perinatology volume 42, pages 907–913 (2022)Cite this article

Subjects

Abstract

Objective

To evaluate multi-organ dysfunction (MOD) in newborns treated with therapeutic hypothermia (TH) for hypoxic ischemic encephalopathy (HIE), and to compare MOD in those with normal/mild magnetic resonance imaging (MRI) findings to those with moderate to severe MRI findings or death.

Study design

Retrospective single-center observational study of infants treated with TH. A total of 16 parameters across 7 organ systems were analyzed. Primary outcome was death or moderate to severe brain injury on MRI.

Result

Of 157 infants treated with TH, 77% had ≥2 organ systems with dysfunction. The number of organ systems with dysfunction was strongly associated with death or moderate-to-severe brain injury (p < 0.0001). Hematologic (68%) and hepatic (65%) dysfunction were most common. Neurologic and renal dysfunction were most strongly associated with the primary outcome (OR 13.5 [6.1–29.8] and 11.2 [4.1–30.3], respectively), while pulmonary hypertension was not.

Conclusion

MOD is prevalent in infants undergoing TH for HIE, and the association between MOD and adverse outcomes may impact clinical care and counseling.

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Fig. 1: Summary of study subject selection.
Fig. 2: Odds ratios for the co-occurrence of each pair of possible organ dysfunctions.
Fig. 3
Fig. 4: Association between organ dysfunction and specific pattern of brain injury in those with moderate to severe injury on MRI.

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Data availability

The data generated in this research will be shared on reasonable request to the corresponding author.

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Funding

EY received salary support from the Einstein Research Fellowship.

Author information

Authors and Affiliations

  1. Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Stanford, CA, USA

    Elisabeth S. Yan, Valerie Y. Chock, Sonia Lomeli Bonifacio, Shazia Bhombal & Krisa Van Meurs

  2. Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA

    Alex Dahlen

  3. Pediatric Radiology Division, University of North Carolina Children’s Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Carolina V. Guimaraes

  4. Department of Pediatrics, Division of Neonatology, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada

    Gabriel Altit

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  1. Elisabeth S. Yan
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Contributions

ESY conceptualized and designed the study, collected the data, extracted the data from the electronic medical record, analyzed the data, drafted the manuscript, and adjusted the manuscript according to the comments of the co-authors. VYC conceptualized and designed the study, supervised data collection, critically appraised the analysis of the data, wrote, and critically reviewed the manuscript for important intellectual content. SLB extracted the data from magnetic resonance imaging, critically appraised the analysis of the data, wrote, and critically reviewed the manuscript for important intellectual content. AD analyzed the data, appraised the analysis of the data, wrote, and critically reviewed the manuscript for important statistical content. CVG extracted the data from magnetic resonance imaging, critically appraised the analysis of the data, and critically reviewed the manuscript for important intellectual content. GA conceptualized and designed the study, extracted the data from echocardiograms, appraised the analysis of the data, and critically reviewed the manuscript for important intellectual content. SB critically appraised the analysis of the data and critically reviewed the manuscript for important intellectual content. KVM conceptualized and designed the study, supervised data collection, critically appraised the analysis of the data, wrote, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Krisa Van Meurs.

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The authors declare no competing interests.

Ethics approval

This study was approved by the Institutional Review Board of Stanford University.

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Yan, E.S., Chock, V.Y., Bonifacio, S.L. et al. Association between multi-organ dysfunction and adverse outcome in infants with hypoxic ischemic encephalopathy. J Perinatol 42, 907–913 (2022). https://doi.org/10.1038/s41372-022-01413-6

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