Neonatal Outcomes in Hypoxic Ischemic Encephalopathy Exposed to Chorioamnionitis, a Retrospective Cohort Study

Hypoxic ischemic encephalopathy (HIE) leads to neonatal mortality and long-term morbidities. Clinical and histological chorioamnionitis is an additional risk factor for neonates with HIE, which could increase morbidity and brain injury. We aimed to assess the short-term outcomes in neonates with HIE exposed to chorioamnionitis.

We conducted a retrospective cohort study using the Canadian Neonatal Network database. We included neonates with ≥35 weeks gestational age with HIE treated with therapeutic hypothermia (TH) born between January 2011 and December 2021. Chorioamnionitis was diagnosed either clinically or histologically. The primary outcome was a composite of mortality and/or brain injury on magnetic resonance imaging. We calculated odds ratios and 95% confidence intervals for the outcomes.

Of the 6212 neonates included, 346 were exposed and 1813 neonates were not exposed to chorioamnionitis. The primary outcome was comparable in both the groups (odds ratio 1.07; confidence interval 0.83, 1.39). Individual components of the primary outcome and other in-hospital morbidities were also similar in both the groups. The primary outcome and neonatal morbidities were also not different in neonates who missed TH. Of note, there was no difference in the incidence of neonatal sepsis in both the groups.

In our study, exposure to chorioamnionitis did not affect the short-term neonatal outcomes irrespective of enrollment in TH.