ORIGINAL ARTICLE

Multiorgan dysfunction in infants with post-asphyxial hypoxic-ischaemic encephalopathy

P Shah¹, S Riphagen², J Beyene¹ and M Perlman²

¹ Department of Paediatrics, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada
² Division of Neonatology, Hospital for Sick Children, Toronto, and Department of Paediatrics, University of Toronto

Correspondence to:
Correspondence to:
Dr Shah
Room 775A, Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5; pshah{at}mtsinai.on.ca

Background: Multiorgan dysfunction (MOD) is one of four consensus based criteria for the diagnosis of intrapartum asphyxia. The theoretical concept behind MOD is the diving reflex (conservation of blood flow to vital organs at the cost of non-vital organs).

Objectives: To assess the patterns of involvement of each major organ/system and combinations of involvement in infants with post-asphyxial hypoxic-ischaemic encephalopathy (HIE), and to describe this in relation to long term outcome.

Design: Retrospective cohort study.

Setting: Regional tertiary neonatal intensive care unit at the Hospital for Sick Children, Toronto, Canada.

Patients: Term neonates with post-intrapartal asphyxial HIE assessed for kidney, cardiovascular system, lung, and liver function.

Outcome: Death and presence or absence of severe neurodevelopmental disability.

Results: Out of 130 of 144 eligible infants with outcome data, 80 (62%) had severe adverse outcome and 50 (38%) had good outcome. All infants had evidence of MOD (at least one organ dysfunction in addition to HIE). Renal, cardiovascular, pulmonary, and hepatic dysfunction was present in 58–88% of infants with good outcome and 64–86% of infants with adverse outcome.

Conclusions: MOD was present in all the infants with severe post-asphyxial HIE. However, there was no association between MOD and outcome in these infants. No relation between individual or combinations of organ involvements and long term outcomes was observed.

Keywords: asphyxia; diving reflex; organ dysfunction

Abbreviations: HIE, hypoxic-ischaemic encephalopathy; MOD, multiorgan dysfunction

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This article has been cited by other articles:

• Roka, A., Melinda, K. T., Vasarhelyi, B., Machay, T., Azzopardi, D., Szabo, M. (2008). Elevated Morphine Concentrations in Neonates Treated With Morphine and Prolonged Hypothermia for Hypoxic Ischemic Encephalopathy. Pediatrics 121: e844-e849 [Abstract] [Full Text]  
• Shah, P. S., Beyene, J., To, T., Ohlsson, A., Perlman, M. (2006). Postasphyxial Hypoxic-Ischemic Encephalopathy in Neonates: Outcome Prediction Rule Within 4 Hours of Birth. Arch Pediatr Adolesc Med 160: 729-736 [Abstract] [Full Text]  
• Vento, M., Sastre, J., Asensi, M. A., Vina, J. (2005). Room-Air Resuscitation Causes Less Damage to Heart and Kidney than 100% Oxygen. Am. J. Respir. Crit. Care Med. 172: 1393-1398 [Abstract] [Full Text]  

eLetters:

Read all eLetters

Questioning the Criteria for Hepatic Involvement In Hypoxic-Ischemic Encephalopathy

Aylin Tarcan, et al.

Fetal Neonatal Ed. Online, 15 Mar 2004 [Full text]

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Fetal Neonatal Ed. Online, 22 Apr 2004 [Full text]

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Fetal Neonatal Ed. Online, 30 Jun 2004 [Full text]

Reply to Morley

Prakesh S Shah, et al.

Fetal Neonatal Ed. Online, 15 Sep 2004 [Full text]

Response to Prof. Shah's Letter

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Fetal Neonatal Ed. Online, 4 Nov 2004 [Full text]