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Updated: Mar 8, 2026
The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
Published on: November 19, 2008
The Severity of Hypoxic-Ischemic Encephalopathy Correlates With Multiple Organ Dysfunction in the Hypothermia Era
Miguel Alsina1, Ana Martín-Ancel, Ana Alarcon-Allen
11Division of Neonatology, Department of Pediatrics, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, University of Barcelona, Spain. 2Department of Pediatrics, Neonatal Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom. 3Department of Neonatology, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain. 4Division of Neonatology, Clinic-Maternitat Hospital. University of Barcelona, Spain. 5Bioestadistics Unit, La Paz University Hospital, Madrid, Spain.
Insights
Hypoxic-ischemic encephalopathy (HIE) in newborns almost always leads to multiple organ dysfunction, especially in the hypothermia era. Severity of HIE strongly correlates with the extent of organ dysfunction in the first 72 hours of life.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal brain injury.
- Multiple organ dysfunction (MOD) is a common complication in HIE.
- The impact of therapeutic hypothermia on MOD in HIE requires further evaluation.
Purpose of the Study:
- To determine the correlation between HIE severity and MOD in neonates.
- To characterize the pattern of organ dysfunction in HIE infants treated with hypothermia.
Main Methods:
- Retrospective observational study of prospective data (2009-2012).
- Included newborns (≥36 weeks gestation, ≥1800g) with HIE diagnosis.
- Assessed HIE severity before hypothermia; studied 6 organ systems and 23 variables over 72 hours.
Main Results:
- All 79 studied infants presented with MOD on day 1.
- HIE severity positively correlated with MOD (AUC 0.77-0.87).
- Hepatic and electrolyte imbalances were most frequent; respiratory and cardiovascular systems were most severely affected.
Conclusions:
- MOD is nearly universal in HIE neonates during the hypothermia era.
- Strong correlation exists between HIE severity and MOD in the first 3 days.
- High suspicion for MOD is crucial in severe HIE; reconsider perinatal cause if MOD is absent in severe neonatal encephalopathy.
Objectives:
The objectives are to 1) determine whether there is a positive correlation between the severity of hypoxic-ischemic encephalopathy and multiple organ dysfunction and 2) evaluate the organ dysfunction pattern in infants with hypoxic-ischemic encephalopathy in the hypothermia era.
Design:
Retrospective observational study of prospective data collected between April 2009 and December 2012.
Setting:
The study took place in the neonatal ICU of Hospital Sant Joan de Déu-Hospital Clínic of Barcelona.
Patients:
Prospective consecutive newborns with greater than or equal to 36 weeks of gestation, greater than or equal to 1,800 g of weight at birth, and a diagnosis of hypoxic-ischemic encephalopathy was included.
Interventions:
Severity of hypoxic-ischemic encephalopathy was established before starting controlled hypothermia. Six organ systems and 23 clinical and laboratory variables were studied by means of an asymmetrical grading scale. Data were recorded daily during the first 72 hours of life.
Measurements And Main Results:
Seventy-nine patients were studied. All presented with multiple organ dysfunction on day 1. There were differences in the number of affected organs on day 1 according to hypoxic-ischemic encephalopathy stage (p < 0.001). Scale scores correlated positively with the severity of hypoxic-ischemic encephalopathy (area under the curve ranged from 0.77 to 0.87 on every day studied). There were significant differences in the severity of dysfunction of each organ system among the three hypoxic-ischemic encephalopathy stages (p < 0.05). Although the most frequently involved were hepatic and pH and electrolyte imbalance, the most severely affected were the respiratory and cardiovascular systems.
Conclusions:
In the hypothermia era, multiple organ dysfunction continues to be almost universal in newborns with hypoxic-ischemic encephalopathy. There is a high correlation between the severity of hypoxic-ischemic encephalopathy and multiple organ dysfunction during the first 3 days of life. A high index of suspicion of relevant multiple organ dysfunction is required in infants admitted with a diagnosis of severe hypoxic-ischemic encephalopathy. Patients with moderate hypoxic-ischemic encephalopathy present wide variability in the severity of multiple organ dysfunction. In the absence of multiple organ dysfunction, a perinatal hypoxic-ischemic origin of acute severe neonatal encephalopathy should be carefully reconsidered.
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