Short-term outcomes after perinatal hypoxic ischemic encephalopathy: a report from the Children's Hospitals Neonatal Consortium HIE focus group.
OBJECTIVE
To characterize infants affected with perinatal hypoxic ischemic encephalopathy (HIE) who were referred to regional neonatal intensive care units (NICUs) and their related short-term outcomes.


METHODS
This is a descriptive study evaluating the data collected prospectively in the Children's Hospital Neonatal Database, comprised of 27 regional NICUs within their associated children's hospitals. A consecutive sample of 945 referred infants born ⩾36 weeks' gestation with perinatal HIE in the first 3 days of life over approximately 3 years (2010-July 2013) were included. Maternal and infant characteristics are described. Short-term outcomes were evaluated including medical comorbidities, mortality and status of survivors at discharge.


RESULTS
High relative frequencies of maternal predisposing conditions, cesarean and operative vaginal deliveries were observed. Low Apgar scores, profound metabolic acidosis, extensive resuscitation in the delivery room, clinical and electroencephalographic (EEG) seizures, abnormal EEG background and brain imaging directly correlated with the severity of HIE. Therapeutic hypothermia was provided to 85% of infants, 15% of whom were classified as having mild HIE. Electrographic seizures were observed in 26% of the infants. Rates of complications and morbidities were similar to those reported in prior clinical trials and overall mortality was 15%.


CONCLUSIONS
Within this large contemporary cohort of newborns with perinatal HIE, the application of therapeutic hypothermia and associated neurodiagnostic studies appear to have expanded relative to reported clinical trials. Although seizure incidence and mortality were lower compared with those reported in the trials, it is unclear whether this represented improved outcomes or therapeutic drift with the treatment of milder disease.
Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA.
A N
AN
Massaro
Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University Chicago, IL, USA.
K
K
Murthy
Children's Hospitals Association, Overland Park, KS, USA.
I
I
Zaniletti
Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
N
N
Cook
Department of Pediatrics, University of Utah and the Primary Children's Medical Center, Salt Lake City, UT, USA.
R
R
DiGeronimo
Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University Chicago, IL, USA.
M
M
Dizon
Emory University Department of Pediatrics and Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.
S E G
SE
Hamrick
All Children's Hospital, St Petersburg, FL, USA.
V J
VJ
McKay
Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA.
G
G
Natarajan
Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Loius, MO, USA.
R
R
Rao
Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA.
D
D
Smith
Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
R
R
Telesco
Florida Hospital for Children, Orlando, FL, USA.
R
R
Wadhawan
Children's Hospital Oakland & Research Center, Neonatal/Pediatric Research, Oakland, CA, USA.
J M
JM
Asselin
Children's Hospital Oakland & Research Center, Neonatal/Pediatric Research, Oakland, CA, USA.
D J
DJ
Durand
Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
J R
JR
Evans
Emory University Department of Pediatrics and Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.
F
F
Dykes
Nationwide Children's Hospital and the Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, USA.
K M
KM
Reber
Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
M A
MA
Padula
Children's Hospitals Mercy and Clinics and the Department of Pediatrics, University of Missouri School of Medicine, Kansas City, MO, USA.
E K
EK
Pallotto
Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA.
B L
BL
Short
Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA.
A M
AM
Mathur
D000138:Acidosis; D015331:Cohort Studies; D004569:Electroencephalography; D005260:Female; D017144:Focus Groups; D006776:Hospitals, Pediatric; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000628:therapy*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012151:Resuscitation; D012640:Seizures / Q000628:therapy*; D016896:Treatment Outcome