title: Perinatal asphyxia with hyperoxemia within the first hour of life is associated with moderate to severe hypoxic-ischemic encephalopathy.
abstract: OBJECTIVE
  To determine whether early hyperoxemia in neonates with severe perinatal acidemia is associated with the development of hypoxic-ischemic encephalopathy (HIE).
  
  
  METHODS
  We identified 120 infants at ≥ 36 weeks gestational age with perinatal acidosis born at Parkland Hospital who qualified for a screening neurologic exam for cooling therapy. Based on a PaO2 measurement during the first hour of life, the cohort was divided into infants with hyperoxemia (PaO2 >100 mmHg) and those without hyperoxemia (PaO2 ≤ 100 mmHg). The rate of moderate-severe encephalopathy was compared between the groups using χ(2) analysis, as well as multiple logistic regression, taking into account baseline characteristics and confounding variables.
  
  
  RESULTS
  Thirty-six infants (30%) had an initial PaO2 >100 mmHg. Infants with and without hyperoxemia had similar baseline maternal and infant characteristics. Infants with hyperoxemia had a higher incidence of HIE than those without hyperoxemia (58% vs 27%; P = .003). Admission hyperoxemia was associated with a higher risk of HIE (OR, 4; 95% CI, 1.4-10.5; adjusted P = .01). Among the neonates with moderate-severe HIE during the first 6 hours of life, those with hyperoxemia had a higher incidence of abnormal brain magnetic resonance imaging results, consistent with hypoxic ischemic injury, compared with those without hyperoxemia (79% vs 33%; P = .015).
  
  
  CONCLUSIONS
  In neonates with perinatal acidemia, admission hyperoxemia is associated with a higher incidence of HIE. Among neonates with HIE, admission hyperoxemia is associated with abnormal brain magnetic resonance imaging findings. The judicious use of oxygen during and after resuscitation is warranted.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Vishal S
authors.initials: VS
authors.lastname: Kapadia
authors.forename: Lina F
authors.initials: LF
authors.lastname: Chalak
authors.forename: Tara L
authors.initials: TL
authors.lastname: DuPont
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Rollins
authors.forename: Luc P
authors.initials: LP
authors.lastname: Brion
authors.forename: Myra H
authors.initials: MH
authors.lastname: Wyckoff
mesh_terms: D000328:Adult; D001237:Asphyxia / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000175:diagnosis*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008423:Maternal Age; D015233:Models, Statistical; D015997:Neonatal Screening / Q000379:methods; D010100:Oxygen / Q000378:metabolism / Q000627:therapeutic use; D012044:Regression Analysis; D012151:Resuscitation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: Eunice Kennedy Shriver National Institute of Child Health and Human Development; HIE; Hypoxic-ischemic encephalopathy; MRI; Magnetic resonance imaging; NICHD; NICU; Neonatal intensive care unit