Multiorgan impact of neonatal encephalopathy: higher burden in preterm infants

Neonatal hypoxic-ischemic encephalopathy (HIE) is the leading cause of neonatal encephalopathy (NE) and is associated with multi-organ dysfunction (MOD) and long-term complications. 1 The impact of oxygen deprivation and redistribution of cardiac output to vital organs is likely higher in preterm neonates (born before 35 weeks of gestation) with the added burden of hypoxia and immaturity. 2 Studies typically focus on term infants, due to limitation of the neurological assessment in preterm examination and lack of therapeutic options in vulnerable preterm group. 3e aim in this brief communication to compare the incidence of and severity of MOD term versus preterm infants.We leverage a prospective neuronicu registry started in 2009 with strict protocols in all infants with suspected HIE to measure laboratory end organ measures for hepatic (AST and ALT), cardiac (troponin and echocardiography), and renal (creatinine and oliguria, based on KDIGO score) injury at birth and prior to discharge. 4sing American Academy of Pediatrics (AAP) established criteria to define HIE, 5 we examined all charts with HIE diagnosis between January 2009 and 2023.Laboratory definitions of MOD included: hepatic injury (AST or ALT > 100 U/L), cardiac injury (troponin T > 0.1 ng/mL and/or abnormal echocardiography), and renal dysfunction (KDIGO-based classification for creatinine and oliguria 4 ).Statistical comparisons between term and preterm infants (<36 weeks gestation) were performed using non-parametric testing (Wilcoxon rank-sum test), with p < 0.05 considered significant.All analyses were completed in R (v4.4.0) under institutional IRB approval, following STROBE guidelines.Of 135,708 live births during the study period, 506 infants were diagnosed with HIE-452 term and 54 preterm (Fig. 1).Preterm infants under 36 weeks gestation accounted for 10% of all birth in this cohort, characteristics summarized in Table 1.The incidence of HIE diagnosis was similar in both groups at 3/1000.Our results reveal contrasting outcomes based on gestational age including higher risk for seizures.Mortality was significantly higher among preterm infants (18% vs. 9%).Multiorgan dysfunction (MOD) was also more prevalent in preterm (80% vs. 57%).Hepatic injury emerged as the most frequent abnormality in both groups (67% in preterm vs. 57% in terms), followed by cardiac (55% vs. 55%) and renal (37% vs. 44%) injuries.Notably, organ involvement was not only more frequent but also more severe in preterm infants.Median AST values on day one were more than twice as high in preterm (277 vs. 130 U/L), and troponin T levels similarly reflected greater myocardial stress (0.3 vs. 0.23 ng/mL).The resolution of organ injury biomarkers was slower in the preterm group.