487 - Trend of Neonatal Hypoxic Ischemic Encephalopathy Prevalence and Associated Risk Factors in the Era of Therapeutic Hypothermia in the United States

Poster Number: 487
Publication Number: 487.343

Ceyda Acun, Cleveland Clinic Children's, Cleveland, OH, United States; Hany Aly, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Sreenivas Karnati, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Swetha Padiyar, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Subhash Puthuraya, Cleveland Clinic Children's Hospital, Cleveland, OH, United States; Mira Younis, Cleveland Clinic Children's, shaker heights, OH, United States; Mohamed A. Mohamed, Cleveland Clinic Children's, Cleveland, OH, United States

Background: Despite recent advances in perinatal care, neonatal hy­poxic–ischemic encephalopathy (HIE) still remains one of the most common causes of neonatal morbidity and mortality.  In addition, recent trends in the prevalence of neonatal HIE have not been examined in the era of therapeutic hypothermia (TH).

Objective: We aimed to determine: 1) the overall and gestational age (GA) specific (35-36 weeks GA, ≥37 weeks GA, and >42 weeks GA) trends of HIE prevalence and use of TH, 2) the trend of mortality in association with HIE, 3) the confounding variables associated with HIE, 4) the clinical outcomes in neonates with HIE.

Design/Methods: We used National Inpatient Sample (NIS) data sets from 2010 to 2018.  We included infants GA ≥35 weeks and birth weight ≥2500 grams, with a documented HIE diagnosis (mild, moderate, severe, unspecified). We calculated trends in HIE prevalence and use of TH using chi square testing and used logistic regression models to control for confounders.

Results: A total of 32,180,617 infants were included; of them 30,041 infants (0.1%) had HIE (any degree). Overall HIE prevalence increased from 0.093% in 2010-2012 to 0.097% in 2016-2018 (p=0.01). There were 6235 (20.8%) infants with HIE were managed with TH. The use of TH increased over the years, 9.1% in 2010 and 23.4 in 2018 (p < 0.01). Mortality in term infants with asphyxia decreased over time from 11.5-12.3% in 2010-2012 to 8.3-10.6% in 2016-2018 (p < 0.01). Maternal hypertension, diabetes, anemia, alcohol or drug use, oligohydramnios, placenta previa or abruption, placental infarction or insufficiency, cord prolapse or nuchal cord, shoulder dystocia, breech or mal presentation, chorioamnionitis, African American race and meconium aspiration were associated with HIE.Conclusion(s): Prevalence of HIE was 1 in 1000 live birth in term infants in the US. Although overall HIE prevalence slightly increased from 2012 to 2018, the use of TH increased and the mortality rate decreased in term infants with HIE. The identification of HIE associated factors should promote increased surveillance to optimize newborn outcomes.
Prevalence of asphyxia and/or hypoxic ischemic encephalopathy
Therapeutic hypothermia in infants with asphyxia and/or hypoxic ischemic encephalopathy