Temporal Trends in the Severity and Mortality of Neonatal Hypoxic-Ischemic Encephalopathy in the Era of Hypothermia

Abstract

<b><i>Introduction:</i></b> There is a paucity of studies examining temporal trends in the incidence and mortality of moderate-to-severe hypoxic-ischemic encephalopathy (HIE) during the last decade of therapeutic hypothermia (TH). <b><i>Methods:</i></b> Multicenter cross-sectional study of all infants ≥35 weeks gestational age diagnosed with moderate-to-severe HIE within 6 h of birth in an extensive region of Spain between 2011 and 2019, in order to detect trend changes over time in the (1) annual incidence, (2) severity of neurological and systemic organ involvement, and (3) neonatal death from HIE. <b><i>Results:</i></b> Annual incidence rate of moderate-to-severe HIE was 0.84 (95% confidence interval [CI] 0.7–0.97) per 1,000 births, without trend changes over time (<i>p</i> = 0.8), although the proportion of severe HIE infants showed an average annual decline of 0.86 points (95% CI 0.75–0.98). There were 102 (70%) infants diagnosed with moderate HIE and 44 (30%) with severe HIE. TH was offered to 139/146 (95%) infants. Infants with clinical and/or electrical seizures showed a decreasing trend from 56 to 28% (<i>p</i> = 0.006). Mortality showed a nonstatistically significant decline (<i>p</i> = 0.4), and the severity of systemic damage showed no changes (<i>p</i> = 0.3). Obstetric characteristics remained unchanged, while higher perinatal pH values (<i>p</i> = 0.03) and Apgar scores (<i>p</i> = 0.05), and less need for resuscitation (<i>p</i> = 0.07), were found over time. <b><i>Conclusion:</i></b> The annual incidence of moderate-to-severe HIE has stabilized at around 1 per 1,000 births, with a temporal trend toward a decrease in severe HIE infants and a slight decline of mortality. No association was found between temporal trends and changes in perinatal/obstetric characteristics over time.

End‐of‐life care over four decades in a quaternary neonatal intensive care unit

“…The observed fall in the proportion of severe birth asphyxia deaths could relate to changes in treatment. A large multi‐centre Spanish study observed a slight decline in mortality from hypoxic‐ischaemic encephalopathy mortality from 2011 to 2019 associated with the use of therapeutic hypothermia 30 . However, the observed change in our study may be more linked to changes in admission patterns.…”

“…A large multi‐centre Spanish study observed a slight decline in mortality from hypoxic‐ischaemic encephalopathy mortality from 2011 to 2019 associated with the use of therapeutic hypothermia. 30 However, the observed change in our study may be more linked to changes in admission patterns. Infants with HIE in Victoria are usually managed in perinatal centres, with our centre increasingly focused on specialised complex surgical and medical conditions.…”

3D doppler ultrasound imaging of cerebral blood flow for assessment of neonatal hypoxic-ischemic brain injury in mice

“…Hypoxic-ischemic encephalopathy (HIE) is a neurologic condition that results from brain injury in neonates due to perinatal conditions such as pre-eclampsia and birth asphyxia. HIE is estimated to occur in 1–8 per 1000 births and is one of the leading causes of morbidity and mortality in infants worldwide [ 1 , 2 ]. At present, there are very limited therapeutic options available besides hypothermia [ 3 ].…”

Research advances in the role of endogenous neurogenesis on neonatal hypoxic-ischemic brain damage

“…Neonatal hypoxic-ischemic brain damage (HIBD), which is caused by perinatal asphyxia, is a primary etiology for acute neonatal mortality and long-term infant neurological dysfunction (1)(2)(3). The incidence of neonatal HIBD is 1-3 per 1,000 in developed countries, while in developing countries the rate can be as high as 25 per 1,000 (4,5).…”