Multi-organ involvement in preterm neonatal encephalopathy

Abstract

BACKGROUND: Hypoxic-ischemic encephalopathy (HIE) is a complex condition resulting from oxygen deprivation at birth. As the body redirects cardiac output to protect the brain, this can lead to multiorgan dysfunction (MOD). While most previous studies traditionally focused on term neonates with HIE, our goal was to focus on preterm neonates to study the effect on organs during critical periods of brain development. We aim to assess the incidence and severity of MOD in relation to brain magnetic resonance imaging (MRI) findings and electroencephalogram (EEG) abnormalities in this vulnerable population. METHODS: Retrospective cohort review of preterm neonates (<35 weeks' gestation) with a diagnosis of neonatal encephalopathy (NE) admitted to the Neonatal Intensive Care Unit (NICU) at Parkland Hospital in Dallas between 2009 and 2023. MOD diagnosis of cardiac, renal, and liver function using clinical and laboratory markers, including echocardiography, serial troponin T, creatinine, urine output, as well as AST and ALT levels during the perinatal period. RESULTS: During the study period, 54 preterm neonates (incidence 0.4/1000) were diagnosed with HIE. All of them had one or more organ injuries and the majority suffered from MOD: 67 % had liver injury (AST 277.0 [68.0, 686.8] IU/L), 55 % had cardiac injury (Troponin T 0.3 [0.2, 0.6] Ng/mL), and 37 % had renal injury (oliguria and creatinine 1.0 [0.8, 1.3]). Those values significantly decreased from Day 1 compared to Day 3 and 6 of life. Additionally, 35 % of newborns had electrographic seizures, 68 % had a discontinuous EEG background, and 83 % had brain MRI/MRS abnormalities supporting HIE. Death occurred in 10 (19 %) due to complications from MOD. CONCLUSIONS: By revealing the significant burden of MOD in preterm infants, this study highlights the need to refine screening and management strategies. Greater vigilance of MOD is crucial for future neuroprotective strategies in this vulnerable population.