WIP 74 - Associations Of In Utero And Neonatal Inflammation With Long-Term Disability After Neonatal Hypoxic Ischemic Encephalopathy

Publication Number: WIP 74.7383

David M. Harary, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States; Elizabeth Wright-Jin, Nemours Children's Hospital, Wilmington, DE, United States; Md Jobayer. Hossain, Nemours Children's Hospital, Wilmington, DE, United States

Background: Hypoxic Ischemic Encephalopathy (HIE) affects 1-3 per 1000 births in developed countries, with a 40% mortality rate. Despite therapeutic hypothermia, 40% of affected infants suffer permanent disabilities. Notably, 50% of neonates with HIE are born to mothers with chorioamnionitis or infection, significantly increasing the risk of HIE and associated neurological conditions such as cerebral palsy (CP), autism, and schizophrenia. The mechanisms underlying these associations remain unclear.

Objective: This study aimed to explore the associations of parental factors, particularly in utero infection, with outcomes in an HIE cohort from Nemours Children’s Health.

Design/Methods: Records of 176 patients diagnosed with HIE (identified via ICD-10 codes, utilizing Sarnat score for HIE severity) from January 2019 to May 2024 were analyzed. Analysis was conducted in R. Chi-square test or Fisher’s exact tests were used to assess associations between categorical variables and ANOVA for continuous variables. Preliminary results indicate an increasing percentage of patients with CP as the severity of the Sarnat score increases. Specifically, CP was not present in patients with a Sarnat score of mild (n=10), occurred in 2% of patients with a Sarnat score of moderate (n=99), and was present in 13% of patients with a Sarnat score of severe (n=67) (p < 0.01). Further analysis indicates significant variation in the prevalence of sepsis and epilepsy relative to Sarnat score severity. Sepsis was present in 10% of patients with mild HIE, 11% of patients with a moderate score, and 25% of patients with a Sarnat score of severe (p=0.04). Epilepsy was observed in 10% of patients with a mild score, 2% of those with a moderate score, and 13% of those with severe HIE (p < 0.02). These findings support the role of neuroinflammatory processes in the severity and outcomes of HIE. Plans to further analyze parental health data is ongoing and will be complete by January. This Study was approved by the Nemours Children’s Health Institutional Review Board (2195695-1).