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Observational Study
. 2023 Dec 14;18(12):e0295759.
doi: 10.1371/journal.pone.0295759. eCollection 2023.

An observational, multicenter, registry-based cohort study of Turkish Neonatal Society in neonates with Hypoxic ischemic encephalopathy

Emel Okulu  1 , Ibrahim Murat Hirfanoglu  2 , Mehmet Satar  3 , Omer Erdeve  1 , Esin Koc  2 , Ferda Ozlu  3   4 , Mahmut Gokce  4 , Didem Armangil  5 , Gaffari Tunc  6 , Nihal Demirel  7   8 , Sezin Unal  8 , Ramazan Ozdemir  9 , Mehmet Fatih Deveci  9 , Melek Akar  10 , Melike Kefeli Demirel  10 , Merih Çetinkaya  11 , Halime Sema Can Buker  11 , Belma Saygılı Karagöl  12 , Deniz Yaprak  12 , Abdullah Barıs Akcan  13 , Ayse Anik  13 , Fatma Narter  14 , Sema Arayici  15 , Egemen Yildirim  15 , Ilke Mungan Akin  16 , Ozlem Sahin  16 , Ozgul Emel Bulut Ozdemir  17 , Fahri Ovali  17 , Mustafa Ali Akin  18 , Yalcin Celik  19 , Aysen Orman  19 , Sinan Uslu  20 , Hilal Ozkan  21 , Nilgun Koksal  21 , Ayhan Tastekin  22 , Mehmet Gunduz  22 , Ayse Engin Arisoy  23 , Resat Gurpinar  23 , Rahmi Ors  24 , Huseyin Altunhan  25 , Ramazan Kececi  25 , Hacer Yapicioglu Yildizdas  3 , Demet Terek  26 , Mehmet Ates  26 , Sebnem Kader  27 , Mehmet Mutlu  27 , Kıymet Çelik  28 , Ebru Yucesoy  29 , Mustafa Kurthan Mert  30 , Selvi Gulasi  30 , Kazım Kucuktasci  31 , Didem Arman  32 , Berna Hekimoglu  33 , Nazlı Dilay Gultekin  34 , Hasan Tolga Celik  35 , Dilek Kahvecioglu  36 , Can Akyildiz  37 , Erdal Taşkın  38 , Nukhet Aladag Ciftdemir  39 , Saime Sundus Uygun  40 , Tugba Barsan Kaya  41 , Arzu Akdag  42 , Aslan Yilmaz  43
Affiliations
Observational Study

An observational, multicenter, registry-based cohort study of Turkish Neonatal Society in neonates with Hypoxic ischemic encephalopathy

Emel Okulu et al. PLoS One. .

Abstract

Background: Hypoxic ischemic encephalopathy (HIE) is a significant cause of mortality and short- and long-term morbidities. Therapeutic hypothermia (TH) has been shown to be the standard care for HIE of infants ≥36 weeks gestational age (GA), as it has been demonstrated to reduce the rates of mortality, and adverse neurodevelopmental outcomes. This study aims to determine the incidence of HIE in our country, to assess the TH management in infants with HIE, and present short-term outcomes of these infants.

Methods: The Turkish Hypoxic Ischemic Encephalopathy Online Registry database was established for this multicenter, prospective, observational, nationally-based cohort study to evaluate the data of infants born at ≥34 weeks GA who displayed evidence of neonatal encephalopathy (NE) between March, 2020 and April 2022.

Results: The incidence of HIE among infants born at ≥36 weeks GA (n = 965) was 2.13 per 1000 live births (517:242440), and accounting for 1.55% (965:62062) of all neonatal intensive care unit admissions. The rates of mild, moderate and severe HİE were 25.5% (n = 246), 58.9% (n = 568), and 15.6% (n = 151), respectively. Infants with severe HIE had higher rates of abnormal magnetic resonance imaging (MRI) findings, and mortality (p<0.001). No significant difference in mortality and abnormal MRI results was found according to the time of TH initiation (<3 h, 3-6 h and >6 h) (p>0.05). TH was administered to 85 (34.5%) infants with mild HIE, and of those born of 34-35 weeks of GA, 67.4% (n = 31) received TH. A total of 58 (6%) deaths were reported with a higher mortality rate in infants born at 34-35 weeks of GA (OR 3.941, 95% Cl 1.446-10.7422, p = 0.007).

Conclusion: The incidence of HIE remained similar over time with a reduction in mortality rate. The timing of TH initiation, whether <3 or 3-6 h, did not result in lower occurrences of brain lesions on MRI or mortality. An increasing number of infants with mild HIE and late preterm infants with HIE are receiving TH; however, the indications for TH require further clarification. Longer follow-up studies are necessary for this vulnerable population.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The flowchart of the study.
Fig 2
Fig 2. Survival analysis and interpretation of initiation time of TH.
See this image and copyright information in PMC

References

    1. van Handel M, Swaab H, de Vries LS, Jongmans MJ. Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review. Eur J Pediatr. 2007;166(7):645–54. doi: 10.1007/s00431-007-0437-8 - DOI - PMC - PubMed
    1. Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists’ Task Force on Neonatal Encephalopathy. Obstet Gynecol. 2014;123(4).896–901. - PubMed
    1. Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic–ischaemic encephalopathy. Early Hum Dev. 2010;86(6):329–38. doi: 10.1016/j.earlhumdev.2010.05.010 - DOI - PubMed
    1. Battin M, Sadler L, Masson V, Farquhar C, Neonatal Encephalopathy Working Group of the PMMRC. Neonatal encephalopathy in New Zealand: Demographics and clinical outcome. J Paediatr Child Health. 2016;52(6):632–6. - PubMed
    1. McIntyre S, Nelson KB, Mulkey SB, Lechpammer M, Molloy E, Badawi N. Neonatal encephalopathy: Focus on epidemiology and underexplored aspects of etiology. Semin Fetal Neonatal Med. 2021;26(4):101265. doi: 10.1016/j.siny.2021.101265 - DOI - PubMed

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