Bitar Lynn, Kota Srinivas, Machie Michelle, Mashat Suleiman, Liu Yu-Lun, Chalak Lina F
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX, USA.
Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX 75220, USA.
Early Hum Dev. 2025 Jun 9;208:106317. doi: 10.1016/j.earlhumdev.2025.106317.
Hypoxic-ischemic encephalopathy (HIE) is a complex condition resulting from oxygen deprivation at birth. As the body redirects cardiac output to protect the brain, this can lead to multiorgan dysfunction (MOD). While most previous studies traditionally focused on term neonates with HIE, our goal was to focus on preterm neonates to study the effect on organs during critical periods of brain development. We aim to assess the incidence and severity of MOD in relation to brain magnetic resonance imaging (MRI) findings and electroencephalogram (EEG) abnormalities in this vulnerable population.
Retrospective cohort review of preterm neonates (<35 weeks' gestation) with a diagnosis of neonatal encephalopathy (NE) admitted to the Neonatal Intensive Care Unit (NICU) at Parkland Hospital in Dallas between 2009 and 2023. MOD diagnosis of cardiac, renal, and liver function using clinical and laboratory markers, including echocardiography, serial troponin T, creatinine, urine output, as well as AST and ALT levels during the perinatal period.
During the study period, 54 preterm neonates (incidence 0.4/1000) were diagnosed with HIE. All of them had one or more organ injuries and the majority suffered from MOD: 67 % had liver injury (AST 277.0 [68.0, 686.8] IU/L), 55 % had cardiac injury (Troponin T 0.3 [0.2, 0.6] Ng/mL), and 37 % had renal injury (oliguria and creatinine 1.0 [0.8, 1.3]). Those values significantly decreased from Day 1 compared to Day 3 and 6 of life. Additionally, 35 % of newborns had electrographic seizures, 68 % had a discontinuous EEG background, and 83 % had brain MRI/MRS abnormalities supporting HIE. Death occurred in 10 (19 %) due to complications from MOD.
By revealing the significant burden of MOD in preterm infants, this study highlights the need to refine screening and management strategies. Greater vigilance of MOD is crucial for future neuroprotective strategies in this vulnerable population.
缺氧缺血性脑病（HIE）是一种因出生时缺氧导致的复杂病症。由于身体会重新分配心输出量以保护大脑，这可能会导致多器官功能障碍（MOD）。虽然此前大多数研究传统上聚焦于足月新生儿的HIE，但我们的目标是聚焦于早产新生儿，以研究在大脑发育关键期对各器官的影响。我们旨在评估这一脆弱群体中与脑磁共振成像（MRI）结果和脑电图（EEG）异常相关的MOD的发生率和严重程度。
对2009年至2023年期间入住达拉斯帕克兰医院新生儿重症监护病房（NICU）、诊断为新生儿脑病（NE）的早产新生儿（孕周<35周）进行回顾性队列研究。使用临床和实验室指标，包括超声心动图、连续肌钙蛋白T、肌酐、尿量以及围产期的谷草转氨酶（AST）和谷丙转氨酶（ALT）水平，对心脏、肾脏和肝脏功能进行MOD诊断。
在研究期间，54例早产新生儿（发生率为0.4/1000）被诊断为HIE。他们均有一个或多个器官损伤，且大多数患有MOD：67%有肝损伤（AST为277.0[68.0，686.8]IU/L），55%有心脏损伤（肌钙蛋白T为0.3[0.2，0.6]Ng/mL），37%有肾损伤（少尿且肌酐为1.0[0.8，1.3]）。与出生后第1天相比，这些数值在出生后第3天和第6天显著下降。此外，35%的新生儿有脑电图癫痫发作，68%有不连续的EEG背景，83%有支持HIE的脑MRI/MRS异常。10例（19%）因MOD并发症死亡。
通过揭示早产婴儿中MOD的重大负担，本研究强调了完善筛查和管理策略的必要性。对MOD保持更高的警惕性对于这一脆弱群体未来的神经保护策略至关重要。
