Multi-organ dysfunction across the neonatal encephalopathy spectrum.

BACKGROUND

Neonatal hypoxic-ischemic encephalopathy (HIE), the leading cause of neonatal encephalopathy (NE), primarily affects the central nervous system and is associated with multi-organ dysfunction (MOD) and long-term complications. Research often focuses on moderate to severe NE, with limited data on mild cases.

OBJECTIVE

To investigate the incidence and severity of MOD in neonates with mild NE and explore its association with HIE severity.

METHODS

Term neonates with NE related to HIE diagnosis between 2009 and 2023 were included. Sarnat staging was used to classify cases into mild and moderate/severe. MOD was assessed on days 1 and 3 post-birth through echocardiography, troponin levels, creatinine levels, urine output, and liver function tests.

RESULTS

Among 452 neonates with HIE (185 mild, 267 moderate/severe), 57% had liver injury, 55% cardiac injury, and 44% kidney injury in the first day of life. Neonates with mild NE had a MOD rate of 23%, lower than the 37% observed in moderate/severe (p = 0.002). When compared to mild, infants with moderate/severe NE had significantly higher incidences of cardiac (69% vs. 31%; p < 0.001), renal (49% vs. 38%; p = 0.067), and hepatic abnormalities (65% vs. 45%; p = 0.005).

CONCLUSIONS

This study highlights the risk of extra-cranial organ injury even in infants with mild NE, stressing the importance of monitoring all regardless of severity.

IMPACT

Comprehensive study prospectively evaluating end-organ dysfunction in a cohort of neonates diagnosed with mild, moderate, and severe NE.