Multi-Organ Dysfunction in Neonatal Hypoxic Ischemic Encephalopathy and Brain Magnetic Resonance Imaging Outcomes

Abstract

Background: Neonates with hypoxic-ischemic encephalopathy (HIE) often exhibit multi-organ dysfunction (MOD). We evaluated the association between MOD (defined as involvement of two or more organ systems) and HIE-related brain magnetic resonance imaging (MRI) findings among neonates with neonatal encephalopathy who underwent therapeutic hypothermia. Methods: Retrospective cohort study of all newborns admitted to the University of Iowa neonatal intensive care unit from January 1, 2008, to June 30, 2022, with encephalopathy who received therapeutic hypothermia. Neonates were classified as having normal or HIE-related changes on MRI. Results: Of 222 newborns, 40% exhibited HIE-related MRI findings. MOD was observed in 56% of all patients. Respiratory issues occurred in 46% of neonates, hepatic and severe neurological dysfunction, defined as seizures or burst suppression in 40%, and cardiac dysfunction in 37%. Severe neonatal encephalopathy was more likely to be associated with MOD. Neonates with HIE changes on MRI were more likely to have MOD than those without (74% vs 45%, P < 0.0001). Neonates with four or more organ dysfunctions had a higher likelihood of abnormal brain MRI (odds ratio = 7.44; 95% confidence interval [CI] 3.51-15.76), and MOD was associated with a greater frequency of global injury on MRI. A logistic regression model showed that the odds ratio for having a brain MRI with HIE findings was 6.63 (95% CI 3.24-13.55, P < 0.0001) with severe neurological dysfunction and 1.95 (95% CI 0.96-3.97, P = 0.065) with cardiac dysfunction. Conclusions: A greater number of organ dysfunctions in neonates undergoing therapeutic hypothermia is associated with HIE-related changes on brain MRI. The highest risk is observed in patients with severe neurological or cardiac dysfunction.