New Insights into Neonates with Hypoxic-Ischemic Encephalopathy

Research results from a retrospective cohort analysis of neonates with hypoxic-ischemic encephalopathy (HIE) published in JAMA Network Open revealed insights into clinical characteristics, outcomes, and costs. Among the findings was a significant association between higher electroencephalography (EEG) costs during the first 4 days of admission with lower odds of death or neurodevelopmental impairment (NDI). There was no association found between higher laboratory or antiseizure medication (ASM) costs and outcomes. In terms of clinical characteristics, neonates who died or survived with NDI were more likely to have an Agpar score < 5 at 10 minutes compared with those who survived without NDI (65.3% vs 39.7%, respectively, P<.001) and less likely to have mild or moderate HIE (36.1% vs 82.3%, respectively, P<.001). With respect to short-term outcomes, neonates who died or survived with NDI were more likely to have had electrographically confirmed seizures, have received inhaled nitric oxide, and had higher median ventilator time than those who survived without NDI.

This retrospective cohort analysis of neonates with HIE who were treated with therapeutic hypothermia (TH) collected data from the Children’s Hospital's Neonatal Database from 2010 to 2016. Information from 11 participating level IV NICUs was analyzed to determine death or NDI. Researchers analyzed the characteristics and costs associated with death or NDI during the first 4 days of age. The Pediatric Health Information Systems (PHIS) was used to determine billing information and estimate resource utilization and cost. Participants (n=381) were included if they had HIE treated with TH, were admitted under 2 days old, were at least 36 weeks’ gestation, and weighed at least 1800 g at birth. Neonates were excluded if they had significant congenital anomalies, if linkage to PHIS was not possible, if they did not survive through the first 4 days of age, or if NDI assessments were not available at 11 months.

There was no statistically significant association between high or medium hospitalization costs and death or NDI (OR, 1.81 [95% CI, 0.63-5.19] vs 1.47 [95% CI, 0.66-3.29], P=.51). Centers with high and medium EEG costs had lower odds of death and NDI when they were compared to centers with a low EEG cost (high vs low: OR, 0.30 [95% CI, 0.16-0.57]; medium vs low: OR, 0.29 [95% CI, 0.13-0.62]; P<.001). When compared to low-cost centers, centers with high (OR, 2.35 [95% CI, 1.19-4.66]) and medium (OR, 1.93 [95% CI, 1.07-3.47]) laboratory costs had higher odds of death and NDI (P=.02). Higher ASM costs were associated with higher odds of death (OR, 3.72 [95% CI, 1.51-9.18]) and NDI (OR, 1.56 [95% CI, 0.71- 3.42]) when compared to lower ASM cost centers (P=.007).

According to the researchers, “Center-driven practices such as increased EEG monitoring may play a role in improving neurodevelopmental outcomes in neonates with HIE and are consistent with neuromonitoring guidelines proposed by the American Clinical Neurophysiology Society and Newborn Brain Society.”