Impaired renal function (IRF), defined as the rate of decline in serum creatinine levels during the week after birth, frequently affects neonates with moderate or severe hypoxic-ischemic encephalopathy (HIE). However, its clinical relevance in this vulnerable population requires further investigation. This study aimed to evaluate the association between IRF and brain injury severity in neonates with HIE. This retrospective single-center study included neonates treated with therapeutic hypothermia for moderate or severe HIE. A multivariable logistic regression analysis evaluated the association between IRF and the combined outcomes of early death or severe brain injury (ED/SevereBI). Of the 147 included neonates, 67 (45.6%) had IRF and 32 (22%) had ED/SevereBI. Those with ED/SevereBI were more likely to have a lower 5-min Apgar score (median [interquartile range]: 4 [2-5] vs. 2 [1-3], P<0.01), have a higher initial blood lactate level (mean cord blood lactate level, +34%, P<0.05), be intubated in the delivery room (50% vs. 75%, P=0.01), and have IRF (39% vs. 69%, P<0.01). After the adjustment for neonatal characteristics and perinatal asphyxia parameters, neonates with IRF had a 2- to 3-fold higher odds of ED/SevereBI than those without IRF (adjusted odds ratio [95% confidence interval]: 2.66 [1.09-6.84], P=0.03). In neonates treated with therapeutic hypothermia for HIE, IRF can be used as a marker of adverse outcomes. Further studies are required to evaluate its long-term prognostic value.

Background: Hypoxic-ischemic encephalopathy (HIE) remains a major cause of neonatal mortality and long term neurodevelopmental impairment worldwide. Therapeutic hypothermia (TH) is currently the standard of care for newborns with moderate-to-severe HIE; however, several aspects of its use remain controversial. Aim: The aim of this paper is to present the current state of knowledge regarding the use of therapeutic hypothermia in newborns with HIE with particular emphasis on mechanisms of action, eligibility criteria, course of therapy, clinical efficacy and adverse effects, as well as to discuss current controversies and directions for further research. Material and methods: A narrative literature review was conducted using the PubMed database to identify studies on therapeutic hypothermia in newborns with hypoxic-ischemic encephalopathy. Publications from the past 11 years were included with particular emphasis on studies published within the last 5 years. Relevant original articles and review papers focusing on clinical outcomes and effectiveness were analyzed. Results: Therapeutic hypothermia reduces the risk of death and severe neurodevelopmental disability in newborns with moderate and severe HIE. Its neuroprotective effects are associated with reduced cerebral metabolism, decreased oxidative stress, modulation of inflammatory response, and inhibition of apoptosis. However, its efficacy in mild HIE and in preterm infants remains inconclusive. The most common adverse effects include cardiovascular, metabolic, and hematological disturbances requiring close monitoring. Conclusions: Therapeutic hypothermia is an effective and relatively safe treatment for HIE; however, it does not completely eliminate the risk of neurodevelopmental impairment. Further research is needed to optimize treatment protocols, expand its use to other populations and evaluate combination therapies.

BackgroundTherapeutic hypothermia (TH) is the standard treatment for moderate to severe hypoxic–ischemic encephalopathy (HIE), yet pain assessment during TH remains challenging. This study compares two validated pain scales in asphyxiated newborns undergoing TH and receiving fentanyl analgesia.MethodsTwenty term infants with HIE treated with TH were enrolled. Pain was assessed using EDIN and N-PASS, while sedation was monitored using the N-PASS sedation subscale.ResultsN-PASS pain and sedation scores significantly decreased by day 3, whereas EDIN scores showed no significant temporal change. Effective analgesia significantly increased over time, either when defined based on EDIN (OR 3.12, p = 0.002) and on N-PASS (OR 3.06, p = 0.007), while N-PASS sedation did not show a time-dependent association. No scale showed a significant association with fentanyl dosage. A moderate positive correlation was found between EDIN and N-PASS pain scores (r = 0.409, p < 0.001). Sedation targets were achieved in only 40%–50% of assessments, with early undersedation and later oversedation observed.ConclusionsEDIN and N-PASS pain scores demonstrate moderate concordance, but capture different dimensions of neonatal pain during TH. N-PASS appears more sensitive to temporal changes, likely due to its combined behavioral and physiological components, whereas EDIN may be affected by hypothermia-related behavioral suppression.

Hypoxic ischemic encephalopathy (HIE) is a severe brain injury that can lead to death and long-term disability. HIE can be treated with therapeutic hypothermia, and various adjuvant treatments (such as melatonin) are also utilized. Adjuvant therapies are not recommended outside clinical trials, and therapeutic hypothermia is not universally available. This study aimed to investigate the effects of Edaravone on improving levels of consciousness, hemodynamic stability, and short-term clinical outcomes of adult patients with severe HIE. To the best of our knowledge, this study is the first randomized clinical trial investigating the effects of Edaravone in adult patients with severe HIE. A double-blind clinical trial enrolled 72 severe HIE patients (aged > 18) within 24 h of onset who were diagnosed clinically and radiologically. Patients were randomized to Edaravone group (n = 20) and non-Edaravone group (n = 52). Measured parameters included level of consciousness, vital signs, Barthel index, and patient outcome (death or discharge). Statistical analysis was performed using SPSS version 27, with a significance level of P < 0.05. In short-term assessment of the patient's level of consciousness, the Edaravone group showed significant improvement in the Glasgow Coma Scale (GCS) post-intervention (p = 0.001). While the Edaravone group and non-Edaravone group showed no significant difference in outcome (p = 0.863) and Barthel score for discharged patients (P = 0.557). Vital signs showed significant differences between groups in temperature (P = 0.002). In the comparison of comorbidities between the Edaravone and non-Edaravone groups, only coronary artery bypass grafting was significantly different (P = 0.021). Edaravone improved the short-term level of consciousness in severe HIE adult patients, but there was no significant effect on outcome and level of independence in performing activities of daily living. Further investigation into Edaravone's effectiveness is warranted, particularly in patients with milder forms of HIE, as well as longer follow-up periods.

BackgroundTherapeutic hypothermia improves survival and neurodevelopmental outcomes in neonates with hypoxic-ischemic encephalopathy when initiated within 6 hours of birth. However, in low- and middle-income countries, delays in referral and access to tertiary care often preclude early initiation and the benefits of therapeutic hypothermia beyond the recommended window remain uncertain. We aimed to assess whether initiating therapeutic hypothermia between 6 and 12 hours after birth is associated with a higher risk of mortality and/or brain injury than initiation within 6 hours in neonates with moderate or severe hypoxic-ischemic encephalopathy.MethodsWe conducted a retrospective cohort study of 173 neonates with moderate or severe hypoxic-ischemic encephalopathy treated with servo-controlled whole-body therapeutic hypothermia at a tertiary care center in Colombia. Neonates were categorized based on the timing of therapeutic hypothermia initiation as ≤6 h or >6–12 h after birth. The primary outcome was a composite of in-hospital mortality and/or brain injury confirmed by magnetic resonance imaging during the first week of life. Multivariate logistic regression was used to adjust for confounding variables.ResultsOf the 173 neonates, 44.5% received therapeutic hypothermia within 6 hours and 55.5% after 6–12 hours. A composite outcome was observed in 40.6% of the patients. Delayed therapeutic hypothermia was not significantly associated with an increased risk of the composite outcome compared to early initiation (adjusted odds ratio [OR]: 1.83; 95% CI: 0.86–3.90). Seizures and severe hypoxic-ischemic encephalopathy were found to be independent predictors of adverse outcomes.ConclusionsIn this cohort, initiation of therapeutic hypothermia between 6 and 12 h after birth was not significantly associated with worse neurological or mortality outcomes than initiation within 6 h. These findings suggest that delayed therapeutic hypothermia may still confer benefits in settings where early initiation is challenging, underscoring the need to strengthen referral systems and further investigate the optimal therapeutic window.

Hypoxic-ischemic encephalopathy (HIE) remains a major cause of neonatal mortality and long-term neurodevelopmental disability. Intranasally delivered mesenchymal stem cells and neurotrophic factors from breast milk have been detected in the central nervous system and may have a role in neuroregenerative processes. F-NEO-BRIGHT (Feasibility- NEOnatal- intranasal BReast milk, Impact on brain Growth in HIE Therapy) is the first clinical study aimed to assess the feasibility and safety of intranasal fresh breast milk (iFBM) in neonates with HIE in both inpatient and home settings. This prospective, single-center study involved ten patients diagnosed with moderate to severe HIE treated with therapeutic hypothermia. Own-mother's fresh breast milk expressed within 4 h, was given intranasally twice daily, 0.4 ml in each nostril, initiated within 48 h of life and continued until day 28. Under continuous cardiorespiratory and neurointensive monitoring in neonatal intensive care, the therapy was well tolerated with no adverse events or side effects observed. The intervention proved to be feasible, treatment initiation was achieved within 48 h in all enrolled neonates and was successfully continued by parents in the home setting. iFBM in neonates with moderate to severe HIE is safe and feasible in both inpatient and home settings. F-NEO -BRIGHT Study is the first clinical trial where intranasal fresh breast milk is administered to neonates with neonatal encephalopathy. Intranasal fresh breast milk administration during the first month of life appears to be feasible, safe and well-tolerated both in hospital and in the home settings. The full therapeutic potential of this treatment could be revealed by further research into long-term neurodevelopmental outcomes.

Therapeutic hypothermia within 6hours of birth is critical for newborns with hypoxic-ischemic encephalopathy (HIE) but is often delayed by transfers to appropriate facilities. Telemedicine (TM) based hypothermia evaluation could expedite these assessments. There is limited evidence on the efficacy of TM compared with the in-person (IP) Sarnat examination. In this study, we aim to compare the TM with the IP examination in infants with suspected HIE. Newborns were enrolled from March 2022 to December 2023. All infants underwent IP and TM assessments using the modified Sarnat examination within 6hours after birth. Data included neurologic examination scores for both IP and TM, decisions for hypothermia qualification, and TM technology metrics. Cohen's kappa statistic (κ) was used to measure the interrater agreement between IP and TM examination findings. 170 Sarnat assessments (IP and TM) were performed on 85 enrolled infants. The results show almost perfect agreement between IP and TM regarding signs of moderate or severe HIE (κ = 0.82) and the decision for hypothermia intervention (κ = 0.82). We report fair to moderate agreement (κ = 0.33-0.58) for individual categories of the neurologic examination. 93% of TM examinations were completed within 15minutes, and 79% of the TM encounters had no technology issues. This study compares IP and TM assessments in infants requiring hypothermia evaluation. Findings show that TM is feasible and not significantly different from IP for making hypothermia decisions in suspected HIE. This could enhance remote Sarnat evaluations and initiate earlier therapeutic interventions.

IGF-1 ameliorates the blood brain barrier disruption induced by the neonatal hypoxia-ischemia.

Laparoscopic management of congenital pyloric Atresia: A case series and surgical perspective.

BackgroundNeonatal hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal mortality and long-term neurodevelopmental morbidity. Accurate bedside neurological assessment is critical for severity stratification and timely clinical decision-making, particularly during the early postnatal period when encephalopathy evolves dynamically. This study aimed to evaluate the correlation, agreement, and time-efficiency between the Modified Sarnat Staging (MSS) system and the Thompson Score (TS) in neonates with HIE, to determine the institutional burden of HIE, and to assess experience-related efficiency characteristics associated with repeated application of both scoring systems.MethodologyA cross-sectional observational study was conducted over an 18-month period in the neonatal intensive care unit (NICU) of Pimpri Chinchwad Municipal Corporation Postgraduate Institute & Yashwantrao Chavan Memorial Hospital, Pimpri, Pune, India. A total of 55 neonates with gestational age ≥35 weeks were enrolled based on the American College of Obstetricians and Gynecologists diagnostic criteria for HIE. The MSS system and the TS were performed at 1, 3, 6, 9, 12, and 24 hours of life, and again at discharge. The time required to complete each assessment was recorded. Severity distribution, correlation (Spearman’s rho), agreement (unweighted and quadratic-weighted kappa), heatmap visualization, and experience-related efficiency trends were analyzed using an available-case methodology.ResultsThe prevalence of HIE among neonates admitted to the NICU during the 18-month study period was 3.26% (227 of 6,965 deliveries). MSS classified 9.09% of neonates as mild, 56.36% as moderate, and 34.55% as severe HIE, whereas the TS identified 40% as mild, 18.18% as moderate, and 41.81% as severe cases. Correlation between the two systems was strong across all timepoints (Spearman’s rho = 0.76-0.91). Agreement improved progressively, with quadratic-weighted kappa increasing from 0.647 at 1 hour to 0.789 at 12 hours and 0.877 at discharge. Heatmap analyses demonstrated early discordance primarily involving infants classified as mild by the TS but moderate by MSS, while severe classifications showed high concordance from the outset. The TS was consistently faster by approximately 55 seconds at all timepoints (Wilcoxon p < 10⁻⁹). Both scoring systems demonstrated marked experience-related improvements (rho = approximately -0.98 to -0.999).ConclusionsThe MSS system and the TS demonstrate strong correlation and progressively improving agreement in the assessment of neonatal HIE. The TS offers a consistent time-efficiency advantage, while early discordance at the mild-moderate boundary underscores the importance of serial neurological assessments and complementary use of both scoring systems during early clinical decision-making.

Despite the decline in the global incidence of neonatal encephalopathy since 1990, 1.0 million infants are still affected every year.1 Therapeutic hypothermia is effective in reducing death or moderate–severe disability in infants with moderate to severe hypoxic-ischaemic encephalopathy (HIE), but questions remain about its efficacy and safety in infants with mild HIE. Mild HIE is not ‘benign’, with neurodevelopmental disabilities reported in 16% to 25% of survivors.2 However, trials focused on mild HIE have yet to identify an effective therapy. A key problem underpinning trial design for infants with mild HIE is its definition – many rely on a combination of biochemical (evidence of birth acidosis), obstetric sentinel events, ongoing receipt of neonatal resuscitation, Apgar scores, and mild HIE on clinical Sarnat staging. The latter is crude, subjective, and does not account for the neurological evolution of HIE within the critical 6-hour time window before therapeutic intervention. Thus, neurodevelopmental outcomes for mild HIE are heterogenous. There is a need for better precision to identify infants at highest risk of later neurodevelopmental problems as candidates for neuroprotection trials. There have been recent attempts to improve early risk stratification within mild HIE. Using data from the PRIME study, Chalak et al.3 developed a scoring system using a total numerical Sarnat score from each of the six categories (range 0–18). The total Sarnat score of ≥5 predicted disability at 18 to 22 months with good accuracy by area under the curve (AUC) 0.83, high sensitivity (100%), and fair specificity (67%). Limitations of this study included a small sample size (n = 43), and no comparison made with the widely used 3-stage modified Sarnat score. Interestingly, when applied retrospectively to hypothermia trial participants with moderate to severe HIE, there was little difference in the AUC estimates, sensitivity, and specificity for death or disability between the total numerical Sarnat score and the modified Sarnat staging.4 An important point of difference between the studies was that the numerical Sarnat in the latter study did not distinguish between normal (score 0) and mild (score 1). The utility of total Sarnat scores in risk stratification of mild HIE warrants further examination. Romeo et al.5 sought to tighten the definition of mild HIE by including a normal amplitude-integrated encephalogram (aEEG) to the biochemical and modified Sarnat criteria. All 40 infants had typical neuromotor development and developmental quotients at 12 months, notwithstanding subtle neurological abnormalities on brain magnetic resonance imaging or a standardized neonatal neurological examination noted in 25% of infants. Inclusion of aEEG may help distinguish severity within mild HIE, and aid in selection of a more severe group for neuroprotective trials. An additional insight gained from Romeo et al.'s study was the natural history of hypotonia, which was noted in 66% of their cohort on initial assessment.5 Whilst other studies had identified tone abnormalities within the first 6 hours as an important predictor of later neurodevelopment,3 all infants in Romeo et al.'s study had normal standardized infant neurological assessments by 6 months, and normal developmental quotients by 12 months. Hypotonia in the first 6 hours as a discriminating sign for later neurodevelopment needs further exploration. So, where does this leave us? The current definition of mild HIE is inadequate and may misclassify risk. New scoring systems for encephalopathy severity, and/or addition of early aEEG, show promise. The utility of new definitions for mild HIE need replication in larger cohorts, ideally pooling data from different geographic regions. Only then can we accelerate efforts to seek better neuroprotection therapies for this group of infants. Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australasian University Librarians Not required.

To perform a systematic review and meta-analysis to examine the association between persistent pulmonary hypertension (PPHN) and receipt of therapeutic hypothermia (TH), compared to those who did not receive TH, among infants with moderate or severe hypoxic-ischemic encephalopathy (HIE). Systematic review and meta-analysis based on Ovid, Medline, Embase and Cochrane central searches from 01/01/2000 to 31/03/2025. We included only randomized control trials for meta-analysis and followed international guidelines for conducting systematic reviews. The primary outcome of the study was PPHN in infants undergoing TH for moderate to severe HIE. Among 185 articles identified using search strategy, 19 articles were assessed for eligibility. Eight randomized control trials (RCTs) met the inclusion criteria, and seven were included in meta-analysis. A random effects model used for the outcome of PPHN, comparing TH with NT or usual care, involving a pooled population of 1006 infants across seven studies. The relative risk of PPHN for TH versus NT was 1.13 (95% confidence interval 0.81 to 1.57). We noted risk of bias in the blinding of participants across included RCTs. We assessed nine observational studies and performed a narrative review. We noted that a considerable number of infants developed PPHN across TH and NT groups. We did not find evidence of an association between TH and PPHN in infants with moderate to severe HIE, although a considerable number of infants developed PPHN across both groups. We suggest that clinicians should be aware of the risk of PPHN to allow prompt investigation and management.

Hypoxic-ischemic encephalopathy (HIE) affects 1.3-1.7 per 1000 live births and remains a major cause of neurodevelopmental impairment (NDI). Despite therapeutic hypothermia (TH), nearly half of infants with moderate to severe HIE experience death or NDI. Identifying early prognostic indicators before TH initiation is crucial for improving management and outcomes. We conducted a retrospective case-control study of 144 infants with HIE treated with TH at Kagoshima City Hospital (2000-2022); 100 underwent developmental evaluations at 18 months. Clinical parameters, including amplitude-integrated EEG (aEEG), Thompson scores, and resuscitation details, were analyzed. Logistic regression identified predictors of adverse outcomes: death, cerebral palsy, or developmental quotient <70. Univariate analysis revealed significant predictors, including low Apgar scores, low umbilical artery pH, aEEG abnormalities, high Thompson scores, and resuscitation details. Multivariate regression identified three independent predictors: aEEG abnormalities (adjusted odds ratios [aOR] 7.1, 95% confidence interval [CI]: 1.3-38.2), Thompson score ≥12 (aOR 5.4, 95% CI: 1.5-18.7), and chest compressions (aOR 31.6, 95% CI: 4.3-231.6). We developed and derived early prognostic model from these predictors, assigning +2 points for aEEG abnormalities, +2 points for a Thompson score ≥12, and +3 points for chest compressions. A total score ≥4 achieved high sensitivity (70.4%) and specificity (90.4%), with an area under the curve of 0.87 (95% CI: 0.77-0.94). The early prognostic model may serve as an effective tool for early risk stratification in neonates with HIE before TH initiation, supporting individualized treatment decisions. This score could help identify high-risk neonates who may benefit from additional neuroprotective strategies.

We aimed to evaluate the efficacy of peritoneal dialysis (PD) in hypoxic-ischemic acute kidney injury (AKI) in newborns with hypoxic-ischemic encephalopathy (HIE) who underwent therapeutic hypothermia (TH). This was a retrospective study including the newborns with HIE/TH who developed hypoxic-ischemic AKI and underwent PD between January 2022 and June 2024. The blood test results obtained before starting PD were compared with the blood test results obtained just before the decision to terminate PD or, in case of death, with the final blood test results obtained before death. Twenty-one newborns were included in the study. Four (19%) of these newborns were diagnosed with moderate HIE, and 17 (81%) were diagnosed with severe HIE. The median gestational age of the patients was 38 (36-39) weeks, and the mean birth weight was 3083 ± 494 g. The median postnatal day when PD started was 3 (2-4) days and its duration was 7 (4-10) days. All patients had fluid overload as an indication for PD dialysis, and fluid overload was accompanied by hyperkalemia in 8 (38.1%) patients. After PD, blood pH, bicarbonate, and sodium values increased significantly (p ≤ 0.001, 0.009, <0.001, respectively), and potassium, phosphorus, and creatinine values decreased significantly (p ≤ 0.001, <0.001, 0.031, respectively) compared with the predialysis values. PD corrects acidosis and electrolyte imbalance and may be considered as a successful renal replacement therapy for hypoxic-ischemic AKI in neonates with HIE/TH, especially in units with limited resources.

Therapeutic hypothermia is currently considered the standard treatment for neonates diagnosed with moderate or severe hypoxic ischemic encephalopathy in high-resource settings, improving survival rates and reducing long-term disability. Consequently, this treatment is increasingly performed in non-pediatric hospitals with intensive neonatal care units. Magnetic resonance imaging plays a fundamental role in assessing the extent of brain injury and represents a key prognostic tool in these patients who present to the neuroradiologist with critical care condition. As the current literature on this topic is flourishing, in this study, we aim to provide a practical guide to the non-pediatric neuroradiologist by summarizing protocols, characteristic radiological findings, and recommendations for ensuring optimal imaging timing by revising published studies.

Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal mortality with limited therapeutic options. This study evaluated the effect of melatonin on short-term outcomes in neonates with HIE. To determine whether adjunctive oral melatonin improves short-term clinical outcomes, including in-hospital survival, in neonates with HIE. A randomized controlled trial enrolled 80 neonates with HIE at Fatemieh Hospital, Hamadan, Iran (2021-2023). The intervention group (n=32) received standard treatment plus 10 mg/kg oral melatonin daily for 5 days, while the control group (n=48) received standard treatment alone. Outcomes included seizure frequency, hospital stay duration, time to initiate oral feeding, time to regain consciousness, adverse effects, and in-hospital survival. Baseline characteristics, HIE severity, medications for seizure control, and paraclinical/imaging findings were comparable between groups (all P&gt;0.05). No significant adverse effects were observed. The intervention group had a higher survival rate (81.2%, 26/32) than the control group (52.1%, 25/48) (P=0.04). There were no significant differences in hospital length of stay, time to start feeding, or time to regain consciousness among surviving neonates (all P&gt;0.05). Adjunctive melatonin may improve in-hospital survival in neonates with HIE and merits further evaluation as an additive therapy.

Prechtl's General Movement Assessment (GMA) and the Hammersmith Infant Neurological Exam (HINE) are recommended for early detection of cerebral palsy (CP) in high-risk infants. These tools are well validated in premature infants but less well studied in the high-risk term population. We sought to determine the added prognostic value of incorporating GMA and HINE assessment in term- and near-term infants with hypoxic ischemic encephalopathy (HIE) who underwent therapeutic hypothermia (TH). In this retrospective and prospective pilot case series of 20 neonates with HIE that were treated with TH, we analyzed the associations between HIE severity, early clinical course, electroencephalography (EEG) background, and magnetic resonance imaging (MRI) injury pattern, with performance on the GMA and HINE. Absence of fidgety movements was significantly associated with severity of EEG background and was most concordant with gray matter injury score on MRI. There were no significant associations between 3-month HINE scores and any clinical measure. Three-month HINE scores were overall lower than published norms for age and tended to normalize over time in patients that had normal fidgety movements. Although the generalizability of these findings is limited because of the small sample size and lack of long-term outcomes, they support incorporation of the GMA as an early outcome in the follow-up of this population for accurate early identification of CP, which is complemented by longitudinal HINE scores for further delineation of severity and topography.

Background and objective: Perinatal asphyxia is a leading cause of neonatal morbidity and mortality, frequently resulting in hypoxic-ischemic encephalopathy (HIE) and multiorgan dysfunction (MOD). During asphyxia, the “diving reflex” preferentially redistributes blood flow to vital organs, predisposing other organ systems to ischemic injury. Data on the burden and pattern of MOD among resuscitated late preterm and term neonates remain limited. The primary objective of this study was to determine the frequency and severity of HIE in late preterm and term neonates requiring resuscitation beyond the initial steps at birth. The secondary objectives were to evaluate the prevalence and pattern of MOD in these infants and to assess the association between HIE severity, organ dysfunction, and mortality.Materials and methods: A prospective observational study was conducted over one year in the neonatal unit and neonatal intensive care unit (NICU) of a tertiary-care hospital, King George’s Medical University (KGMU), Lucknow, India. A total of 164 neonates (≥34 weeks’ gestation) who required resuscitation beyond initial steps were enrolled after obtaining informed parental consent. Demographic, perinatal, and clinical data were recorded. Organ dysfunction was evaluated using clinical and biochemical criteria for the central nervous, cardiovascular, renal, hepatic, respiratory, hematologic, and metabolic systems. The severity of HIE was graded using Sarnat and Sarnat staging. Statistical analysis was performed using IBM SPSS Statistics software, version 26 (IBM Corp., Armonk, NY, USA), with p <0.05 considered significant.Results: Among 164 neonates requiring resuscitation, 40% (66/164) developed HIE, with Stage III being most common (51.5%). MOD was frequent, with metabolic derangements (81.1%) and renal (55.5%) being the most prevalent. Overall mortality was 20.7% (34/164), highest among neonates with cardiovascular dysfunction (54.9%) and HIE III (79.4%). The intensity of resuscitation correlated with organ involvement: prolonged positive pressure ventilation (PPV) >1 min, intubation, chest compressions, and drug use were significantly associated with higher rates of central nervous system (CNS), cardiovascular, renal, respiratory, hematological, gastrointestinal, and metabolic dysfunction (p<0.05).Conclusion: HIE and MOD are common in late preterm and term neonates requiring resuscitation beyond initial steps, with the severity of HIE closely linked to the extent of organ involvement and mortality. Early recognition and close monitoring of MOD are essential to improve outcomes in this high-risk population.

Introduction: Birth asphyxia remains a major contributor to neonatal morbidity and mortality. Identifying clinical and biochemical characteristics linked to mortality may help improve care in resource-limited settings. This study examined the relationship between admission clinical and biochemical features and short-term mortality among asphyxiated neonates. Methods: An institutional-based cross-sectional study was conducted among 288 asphyxiated neonates admitted to public NICUs in Addis Ababa between January and December 2022. Data were extracted using a pre-tested tool, and associations were assessed using chi-square tests. Results: Overall mortality was 18.4%. Death was more frequent among neonates with severe hypoxic-ischemic encephalopathy, abnormal neurological signs, hypothermia, hypoglycemia, seizures, and hyperbilirubinemia. Non-survivors had higher potassium, liver enzymes, and creatinine and lower sodium and calcium levels. Median hospital stay was shorter among non-survivors. Conclusion: Several clinical and biochemical features at admission were associated with mortality among asphyxiated neonates, highlighting the importance of early risk identification in NICUs.

The Prognostic Weight of Clinical, Biochemical, Electrographic, and Neuroimaging Biomarkers in Perinatal Hypoxic-Ischemic Encephalopathy Spectrum.