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Perinatal asphyxia with hyperoxemia within the first hour of life is associated with moderate to severe
Vishal S Kapadia1, Lina F Chalak, Tara L DuPont
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
Insights
Early high oxygen levels (hyperoxemia) in newborns with perinatal acidemia increase the risk of hypoxic-ischemic encephalopathy (HIE). This condition is also linked to abnormal brain MRI findings, highlighting the need for careful oxygen use.
Area of Science:
- Neonatal Medicine
- Perinatal Research
- Neurology
Background:
- Perinatal acidemia is a significant risk factor for neonatal brain injury.
- Hypoxic-ischemic encephalopathy (HIE) is a serious condition affecting newborns exposed to oxygen deprivation.
- The role of early oxygen administration in neonates with acidemia requires further investigation.
Purpose of the Study:
- To investigate the association between early hyperoxemia and the development of HIE in neonates with severe perinatal acidemia.
- To determine if initial hyperoxemia influences the severity of HIE and associated brain injury.
Main Methods:
- A cohort of 120 infants (≥36 weeks gestational age) with perinatal acidosis was identified.
- Infants were categorized into groups based on PaO2 levels (>100 mmHg for hyperoxemia, ≤100 mmHg otherwise) within the first hour of life.
- Moderate-to-severe encephalopathy rates were compared using statistical analyses, including logistic regression, controlling for confounding variables.
Main Results:
- 30% of infants exhibited initial hyperoxemia (PaO2 >100 mmHg).
- Hyperoxemia was significantly associated with a higher incidence of HIE (58% vs. 27%, P = .003).
- Admission hyperoxemia increased the risk of HIE (OR, 4; adjusted P = .01) and was linked to abnormal brain MRI findings in HIE cases (79% vs. 33%, P = .015).
Conclusions:
- Early hyperoxemia in neonates with perinatal acidemia is associated with an increased incidence of HIE.
- In neonates with HIE, hyperoxemia correlates with abnormal brain MRI findings, suggesting more severe hypoxic-ischemic injury.
- Judicious oxygen administration during and after resuscitation is recommended for this vulnerable population.
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 χ(2) 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.
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