P2.G132: Multiple Organ Involvement in Neonates with Hypoxic-Ischemic Encephalopathy: Not Just Brain

Background: Hypoxic ischemic encephalopathy (HIE) potentially affects multiple organs: heart, liver, and kidneys, leading to long-term complications. To date, few studies have evaluated multi-organ dysfunction (MOD) in neonates with HIE, particularly those classified as mild.
To evaluate the incidence and extent of MOD in neonates with mild, moderate, and severe HIE; and to establish the correlation between HIE severity and extent of organ involvement.

Methods: We included term neonates with HIE admitted to the NICU (Parkland) between 2009-2023. They were divided into two groups based on Sarnat staging: Mild and Moderate to Severe HIE. MOD was assessed with 1) cardiac function using echocardiography and serial troponin T, 2) renal function using serial creatinine and BUN, 3) liver function using serial AST and ALT on days 1 and 3 after birth.

Results: We included 452 neonates: mild HIE (185), moderate to severe HIE (267). Among the whole cohort, 57% had liver injury, 55% cardiac injury, and 44% kidney injury. Neonates with moderate to severe HIE showed a significantly higher incidence of hepatic (65% vs. 45%; p=0.005), cardiac (69% vs. 31%; p< 0.001), and renal (49% vs. 38%; p=0.067) injury compared to those with mild HIE. Neonates with all grades of HIE exhibited a high rate of MOD (moderate to severe 37% vs mild HIE 23%; p=0.002).

Conclusion: This study highlights the high risk of extra-cranial organ injury in all HIE even those with mild encephalopathy. This emphasizes the importance of close monitoring of biomarkers of end organ function in neonates with HIE, regardless of severity.