TOP 70 - Evaluating the Impact of NICU Monitoring for Infants with Low Cord pH: Identifying Predictors for HIE and Evaluating Associated Clinical Outcomes

Publication Number: 3802.TOP 70

Denise Klein, USF Health Morsani College of Medicine, LARGO, FL, United States; Tara M. Randis, University of South Florida, Tampa, FL, United States; Jose Duncan, University of South Florida, Tampa, FL, United States; Fairicy A. del Cid, USF, Land o Lakes, FL, United States; Ambuj Kumar, University Of South, Tampa, FL, United States; Marcia Kneusel, University of South Florida, Tampa, FL, United States; Jaime Flores-Torres, University of South Florida, Tampa, FL, United States

Background: Hypoxic-ischemic encephalopathy (HIE) is a significant cause of neonatal morbidity and mortality, affecting 1–2 per 1,000 live births. Despite advances in care, HIE rates have remained stable, highlighting the need for improved early recognition of neonates at risk. At our institution, neonates with a cord pH /= 10 are admitted to the neonatal intensive care unit (NICU) for close monitoring and examinations. This study is expected to help identify subgroups of neonates who may benefit from closer monitoring or early interventions due to a higher risk of adverse outcomes.  Findings may also help other centers in developing protocols or guidelines for the management of infants born with metabolic acidosis.

Objective: This study aims to identify which clinical factors within this population will be predictive of the development of moderate to severe HIE and to evaluate clinical outcomes associated with NICU observation and early detection strategies.

Design/Methods: This is a single-center retrospective cohort study conducted at Tampa General Hospital (TGH) from January 1, 2023, to December 31, 2024. All consecutive neonates admitted to the NICU for observation due to metabolic acidosis on umbilical cord gas samples at birth with gestational age greater than 35 weeks, birth weight over 1.8 kg, and umbilical cord pH /= 10 were eligible for inclusion. Infants with major congenital anomalies or those transferred from outside hospitals were excluded.

621 infants met the inclusion criteria, with a case-to-control ratio of about 1:30. Data were extracted from the medical record and entered into REDCap for analysis. Maternal, perinatal, and neonatal variables were collected, as well as clinical outcomes and adverse events.

Infant characteristics will be summarized as mean ± standard deviation or median (interquartile range) for continuous variables and as frequencies and percentages for categorical variables. The difference in continuous variables across compared groups will be assessed using Student’s t-test or Mann–Whitney U test, as appropriate, and using Chi-square or Fisher’s exact tests for Categorical variables. Variables demonstrating p-values < 0.10 in univariate analysis will be entered into a multivariable logistic regression model to identify independent predictors of moderate to severe HIE and summarized as odds ratios with 95% confidence intervals. A two-tailed p-value < 0.05 will be considered statistically significant. All analyses will be performed using the IBM SPSS analytical package.

Tables for results
Met Acidosis - Tables.pdfPending data analysis