In-Hospital Outcomes of Neonates with Hypoxic–Ischemic Encephalopathy Receiving Sedation–Analgesia during Therapeutic Hypothermia

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Abstract This study aimed to compare magnetic resonance imaging (MRI) severity scores and in-hospital outcomes among neonates with perinatal hypoxic–ischemic encephalopathy (HIE) with and without exposure to sedation–analgesia (SA) during therapeutic hypothermia (TH). A single-center, retrospective cohort study of neonates with perinatal HIE undergoing TH between January 2010 and December 2020. Demographics, clinical characteristics, MRI scores, and in-hospital outcomes were compared between patients without SA exposure and those with SA use. Of the 131 neonates, 55 (42%) did not have SA exposure, and 76 (58%) had SA during TH. Groups were similar in birth weight, gestational age, and severity of HIE. A higher proportion of neonates in the SA group received inhaled nitric oxide (iNO, 39.4 vs. 2%, p < 0.001) and vasopressors (41 vs. 20%, p = 0.012) compared to no SA group. There was no difference in median MRI severity scores for neither T1 (2 [2, 4.25] vs. 3 [2, 6], p = 0.295), T2 (2 [0, 3] vs. 3 [1.5, 5.5], p = 0.088) nor diffusion-weighted images (0 [0, 2] vs. 0 [0, 4.25], p = 0.090) between SA and no SA groups, respectively. In-hospital outcomes were similar between groups except for lower survival to discharge (87 vs. 98%, p = 0.020) in the SA group compared to those without SA. A regression analysis showed death was associated with the concomitant use of iNO (p < 0.001) and inotropes (p < 0.001). SA during TH for perinatal HIE did not alter early MRI severity scores. A lower survival to discharge in the SA group may be related to illness severity rather than SA use alone.

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