Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
Ther Hypothermia Temp Manag. 2021 Mar;11(1):58-63. doi: 10.1089/ther.2020.0035. Epub 2020 Nov 5.
Hypoxic ischemic encephalopathy (HIE) is a serious neurological complication that may develop in asphyxiated infants. Severity of encephalopathy may vary, and concurrent multiorgan dysfunctions are commonly observed. Analyzing the incidence of such complications according to severity of HIE, and how they correlate with each other, may shape clinical judgment and allow for early intervention. The study included a total of 57 HIE infants, in which 27/57 (47.37%) met Sarnat inclusion criteria for moderate stage II HIE (Group A) and 30/57 (52.63%) for severe stage III HIE (Group B). Both groups were assessed and compared for incidence of kidney dysfunction, liver dysfunction, coagulopathy, qualitative cardiac abnormalities, respiratory-related dysfunction, and bone marrow insufficiency/thrombocytopenia. All assessments were performed before initiation of therapeutic hypothermia. The complications were further assessed for the presence of correlations. Group B experienced significantly higher incidence of kidney dysfunction (A: 2/27 [7.4%] vs. B: 21/30 [70%], < 0.001), liver dysfunction (A: 14/27 [51.8%] vs. B: 28/30 [93.3%], < 0.001), and thrombocytopenia (A: 8/27 [29.6%] vs. B 21/30 [70%], = 0.002) in our study group. Kidney dysfunction and bone marrow insufficiency showed the highest affiliation with other organ systems in both groups, correlating positively with each other as well as HIE severity, cardiac abnormalities, liver dysfunction, and infant death. A total of 8/57 (14%) infant deaths were observed, all originating from grade III severe HIE group ( = 0.003). Multiorgan dysfunction showed a significant difference between HIE severity (A: 12/27 [44.4%] vs. B: 28/30 [93.3%], < 0.001). A positive correlation was obtained between multiorgan dysfunction, HIE severity, and infant death. Stage III HIE infants are more likely to experience abnormalities in the kidneys, liver, bone marrow as compared with stage II HIE infants. Correlations between organ complications are present, and should be taken into account during clinical assessment of HIE infants. The probability of mortality is higher in stage III HIE infants with observed multiorgan dysfunctions.
缺氧缺血性脑病（HIE）是一种严重的神经系统并发症，可能发生在窒息的婴儿中。脑病的严重程度可能不同，同时存在多器官功能障碍是很常见的。根据 HIE 的严重程度分析这些并发症的发生率，以及它们之间的相关性，可能有助于临床判断，并允许早期干预。该研究共纳入 57 例 HIE 婴儿，其中 27/57（47.37%）符合 Sarnat 中度二期 HIE（A 组）纳入标准，30/57（52.63%）符合重度三期 HIE（B 组）。对两组患者进行评估，并比较肾功能障碍、肝功能障碍、凝血功能障碍、心脏异常、呼吸相关功能障碍和骨髓功能不全/血小板减少症的发生率。所有评估均在开始治疗性低温之前进行。进一步评估并发症之间的相关性。B 组患者肾功能障碍（A：2/27[7.4%]vs.B：21/30[70%]， < 0.001）、肝功能障碍（A：14/27[51.8%]vs.B：28/30[93.3%]， < 0.001）和血小板减少症（A：8/27[29.6%]vs.B：21/30[70%]， = 0.002）的发生率明显更高。在我们的研究组中，肾功能障碍和骨髓功能不全与其他器官系统的相关性最高，与 HIE 严重程度、心脏异常、肝功能障碍和婴儿死亡呈正相关。共观察到 8/57（14%）例婴儿死亡，均来自 III 级重度 HIE 组（ = 0.003）。HIE 严重程度之间多器官功能障碍差异有统计学意义（A：12/27[44.4%]vs.B：28/30[93.3%]， < 0.001）。多器官功能障碍、HIE 严重程度和婴儿死亡之间存在正相关。与 II 期 HIE 婴儿相比，III 期 HIE 婴儿更易发生肾脏、肝脏、骨髓异常。器官并发症之间存在相关性，在对 HIE 婴儿进行临床评估时应予以考虑。观察到多器官功能障碍的 III 期 HIE 婴儿的死亡率更高。
