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

Objective 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). Study Design 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. Results 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). Conclusion 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. Key Points Conflicting studies exist regarding the efficacy of SA use during TH. SA use during TH did not alter in-hospital MRI severity scores. SA use was associated with a lower survival to discharge, correlated to the severity of illness rather than SA use alone.