Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy.

BACKGROUND

Multiorgan dysfunction (MOD) is one of four consensus based criteria for the diagnosis of intrapartum asphyxia. The theoretical concept behind MOD is the diving reflex (conservation of blood flow to vital organs at the cost of non-vital organs).

OBJECTIVES

To assess the patterns of involvement of each major organ/system and combinations of involvement in infants with post-asphyxial hypoxic-ischaemic encephalopathy (HIE), and to describe this in relation to long term outcome.

DESIGN

Retrospective cohort study.

SETTING

Regional tertiary neonatal intensive care unit at the Hospital for Sick Children, Toronto, Canada.

PATIENTS

Term neonates with post-intrapartal asphyxial HIE assessed for kidney, cardiovascular system, lung, and liver function.

OUTCOME

Death and presence or absence of severe neurodevelopmental disability.

RESULTS

Out of 130 of 144 eligible infants with outcome data, 80 (62%) had severe adverse outcome and 50 (38%) had good outcome. All infants had evidence of MOD (at least one organ dysfunction in addition to HIE). Renal, cardiovascular, pulmonary, and hepatic dysfunction was present in 58-88% of infants with good outcome and 64-86% of infants with adverse outcome.

CONCLUSIONS

MOD was present in all the infants with severe post-asphyxial HIE. However, there was no association between MOD and outcome in these infants. No relation between individual or combinations of organ involvements and long term outcomes was observed.