Original Article
Perinatal Asphyxia with Hyperoxemia within the First Hour of Life Is Associated with Moderate to Severe Hypoxic-Ischemic Encephalopathy

https://doi.org/10.1016/j.jpeds.2013.04.043Get rights and content

Objective

To determine whether early hyperoxemia in neonates with severe perinatal acidemia is associated with the development of hypoxic-ischemic encephalopathy (HIE).

Study design

We identified 120 infants at ≥36 weeks gestational age with perinatal acidosis born at Parkland Hospital who qualified for a screening neurologic exam for cooling therapy. Based on a PaO2 measurement during the first hour of life, the cohort was divided into infants with hyperoxemia (PaO2 >100 mmHg) and those without hyperoxemia (PaO2 ≤100 mmHg). The rate of moderate-severe encephalopathy was compared between the groups using χ2 analysis, as well as multiple logistic regression, taking into account baseline characteristics and confounding variables.

Results

Thirty-six infants (30%) had an initial PaO2 >100 mmHg. Infants with and without hyperoxemia had similar baseline maternal and infant characteristics. Infants with hyperoxemia had a higher incidence of HIE than those without hyperoxemia (58% vs 27%; P = .003). Admission hyperoxemia was associated with a higher risk of HIE (OR, 4; 95% CI, 1.4-10.5; adjusted P = .01). Among the neonates with moderate-severe HIE during the first 6 hours of life, those with hyperoxemia had a higher incidence of abnormal brain magnetic resonance imaging results, consistent with hypoxic ischemic injury, compared with those without hyperoxemia (79% vs 33%; P = .015).

Conclusion

In neonates with perinatal acidemia, admission hyperoxemia is associated with a higher incidence of HIE. Among neonates with HIE, admission hyperoxemia is associated with abnormal brain magnetic resonance imaging findings. The judicious use of oxygen during and after resuscitation is warranted.

Section snippets

Methods

This was a retrospective cohort study conducted at Parkland Memorial Hospital in Dallas, Texas, which has a high-risk perinatal service with ∼15 000 deliveries annually and is a regional level III neonatal intensive care unit (NICU) receiving 1300-1500 admissions each year. This project was approved by the Institutional Review Board of the University of Texas Southwestern Medical Center. Subjects were identified by retrospective review of 2 prospectively collected databases, the Parkland

Results

Of the 60 743 infants born occurring at Parkland Hospital during the study period, 4815 were admitted to the NICU, and 120 met our eligibility criteria for this study (Figure 1). Among the eligible infants, 36 (30%) had hyperoxemia at admission and 84 (70%) did not have hyperoxemia. Maternal perinatal risk factors, including age and rates of preeclampsia, prolonged rupture of membranes, chorioamnionitis, presence of meconium-stained amniotic fluid, abruption, fetal heart rate deceleration, and

Discussion

Here we report an association between hyperoxemia on admission to the NICU within the first hour of life in neonates with perinatal acidemia and the development of moderate to severe HIE in these neonates. In our series, the incidence of HIE was associated with the degree of hyperoxemia on admission. In addition, neonates with moderate-severe HIE demonstrated an association between early hyperoxemia and abnormal brain MRI performed between 5 and 10 days of life.

Our study examined all inborn

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    The authors declare no conflicts of interest.

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