Short and long-term outcomes in neonatal hypoxic-ischemic encephalopathy treated with hypothermia and vasoactive medications.

Background: Hemodynamic instability in neonatal hypoxic-ischemic encephalopathy (HIE) can contribute to brain injury but long-term neurodevelopmental data is limited. Our objective was to compare the effect of hemodynamic instability requiring vasoactive support on radiologic brain injury and neurodevelopmental outcomes in HIE with therapeutic hypothermia (TH). Methods: This retrospective cohort study compared infants with HIE post-TH who did not require (Group I) versus those who required vasoactive medications (Group II). The association between hemodynamic instability and MRI brain injury or Bayley Scales of Infant Development III (BSID-III) was evaluated by logistic regression. Results: Among 185 infants, group II had higher adjusted odds of moderate-severe grey matter injury [odds ratio 5.54; 95% confidence interval 1.70 - 18.05; p < 0.001] than group I, with no differences in adjusted 18-24-month BSID-III scores. Conclusion: Hemodynamic instability requiring vasoactive support in HIE with TH was associated with higher odds of radiologic brain injury but no difference in neurodevelopmental outcomes.