WIP 69 - Cognitive Outcomes of Neonates with Hypoxic-Ischemic Encephalopathy Treated with Hypothermia: The Impact of Neighborhood Deprivation

Publication Number: WIP 69.7704

Srishti Jayakumar, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Corina Mills, Johns Hopkins University, Baltimore, MD, United States; Carolei Bryan, Johns Hopkins Children's Center, Baltimore, MD, United States; Kathryn Carson, Bloomberg School of Public Health, Baltimore, MD, United States; Jordan Richard. Kuiper, George Washington University Milken Institute School of Public Health, Washington, DC, United States; Amii M.. Kress, Johns Hopkins University, Epidemiology Department, Baltimore, MD, United States; Amaris Keiser, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Frances Northington, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Gwendolyn Gerner, Kennedy Krieger Institute, Baltimore, MD, United States; Vera Joanna Burton, Kennedy Krieger Institute, Baltimore, MD, United States

Background: The role of maternal, fetal, and neonatal factors in neurodevelopmental outcomes of infants surviving hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) is established. However, there is a dearth of literature examining how sociodemographic factors affect neurodevelopmental outcomes in these neonates. While some data exists describing individual-level factors, there is limited data assessing the impact of neighborhood-level social determinants of health on the development of infants surviving hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH).

Objective: Our aim was to elucidate the relationship between neighborhood-level socioeconomic disadvantage and cognitive outcomes of neonates surviving HIE.

Design/Methods: This is an IRB-approved retrospective chart review of neonates surviving HIE treated with TH who participated in follow-up at the high risk clinic and completed a series of neurodevelopmental assessments. Using electronic medical records, we obtained clinical characteristics including birth anthropometrics, gestational age, sex, cord pH, cord base deficit, Apgar scores at 1 and 5 min, brain MRI NICHD scores, peak creatinine and alanine transaminase levels within the first 72h of life, need for pressors, steroids and/or inhaled nitric oxide, presence of coagulopathy and/or seizures. Using this data, we are constructing a score to reflect the severity of HIE for each patient. We also collected individual sociodemographic factors including insurance status, parental education, median income, driving distance from the clinic, self-reported race and ethnicity. We are collecting neurodevelopmental outcomes tested using the Mullen Scale at 24 months of age. For each patient, we will use street addresses to determine the Area Deprivation Index score, a well-validated index consisting of income, education, employment, and housing quality. We will conduct regression analyses to assess differences in cognitive outcomes in Mullen subscales by ADI scores adjusted for severity of HIE.