37 - Neurodevelopmental Outcomes of Infants with Hypoxic Ischemic Encephalopathy with and without Perinatal infection: A Retrospective Cohort Study

Publication Number: 1030.37

Namrata Todurkar, University of Calgary, Calgary, AB, Canada; Selphee Tang, Alberta Health Services, Calgary, AB, Canada; Mouhanad Alnirabiah, university of calgary, Calgary, AB, Canada; Stephanie Nneka. Uwajeh, University of Calgary, Calgary, AB, Canada; Leonora Hendson, University of Calgary, Calgary, AB, Canada; Hussein Zein, University of Ca=ary Cumming School of Medicine, Calgary, AB, Canada; Shabih Hasan, University of Calgary, Calgary, AB, Canada; Kamran Yusuf, Kamran Yusuf, Department of Pediatrics, University of Calgary, Calgary, AB, Canada

Background: Hypoxic Ischemic Encephalopathy (HIE) is a devastating complication of newborns potentially leading to adverse long term neurodevelopmental sequalae. Whether perinatal infection worsens neurodevelopmental outcome in infants with HIE is not well established.

Objective: To investigate neurodevelopmental outcome of infants cooled for HIE, with and without perinatal infection.

Design/Methods: Retrospective cohort study of infants cooled for HIE with placental pathology based on the Amsterdam classification between 2014 and 2023. Infants with chromosomal and major congenital abnormalities, and those lost to follow up were excluded. Perinatal infection was defined as a positive blood/ cerebrospinal fluid culture and/or placental histopathology based on the Amsterdam classification showing maternal inflammatory reaction and /or fetal inflammatory reaction and/or funisitis. The primary outcome was a score of < 85 on either the cognitive, language, or motor components of the Bayley Scales of Infant and Toddler Development (Bayley-III/IV). Secondary outcomes included separate cognitive, language, and motor components of the Bayley-III/IV ,death, cerebral palsy of any type or severity, deafness or blindness, and screened as high risk for or confirmed diagnosis of autism. . Outcomes were assessed at 21 months corrected age. Variables were compared using Chi square tests, Fisher's exact tests, t-tests, and Mann-Whitney U tests. Logistic regression models were used to calculate adjusted odds ratios with 95% confidence intervals.

Results: Of the 156 infants eligible for the study, 62 (39.7%) were exposed to perinatal infection (Figure). There was no difference between the two groups except for clinical chorioamnionitis and gestational age, higher in the perinatal infection group and C-section rates, higher in the no perinatal infection group (Table 1). On univariate analysis, there was no difference between the two groups in the primary or secondary outcomes (Table 2). On logistic regression, accounting for confounders, the primary outcome was not significantly different between the two groups, odds ratio 1.18 95% confidence interval 0.38-3.56.

Conclusion(s): There was no difference in neurodevelopmental outcome of cooled HIE infants with and without perinatal infection. This is the first study to report on neurodevelopmental outcome using Bayley -III/IV in infants with HIE and perinatal infection based on the Amsterdam classification of placental histopathology. Our results need validation in larger cohorts.

FIGURE. FLOW DIAGRAM OF THE STUDY POPULATION


TABLE 1. MATERNAL AND NEONATAL CHARACTERISTICS


TABLE 2: NEURODEVELOPMENTAL OUTCOMES AT 21 MONTHS CORRECTED AGE