(48) Sex differences in Neurological Outcomes of Neonates with Hypoxic Ischemic Encephalopathy

Background: Hypoxic Ischemic Encephalopathy (HIE) is an important cause of morbidity and mortality in neonates worldwide. The basic science literature on neonatal HIE discusses male neonates having worse outcomes than females, however there is currently no clinical data to definitively support this.

Objectives: Therefore, we aim to analyze the sex differences in neuroimaging and neurodevelopmental outcomes of neonates with HIE.

Design/Methods: This is an IRB approved retrospective study of neonates admitted to the American Family Children’s Hospital (AFCH) NICU between 1/1/2010 - 5/31/2024 and included in the Children's Hospitals Neonatal Consortium Database (CHND). Data related to demographics, birth, therapeutic hypothermia, EEG, seizures, NICU therapies were obtained from the CHND. Neuroimaging (brain MRI) at birth, and neurodevelopmental outcomes data was extracted from the Patient Health Links records. All data will be entered into the REDCAP data base and will be analyzed in depth, outcome measures will be analyzed using Fisher's Exact Test and relative risk ratios will be calculated.

Results: Preliminary data was available for the 66 neonates (43 males, 23 females). Of the 43 males, 10 (23%) were classified as having mild, 25 (58%) as moderate and 7 (19%) as severe HIE. Of the 23 females, 4 (17%) were classified as having mild, 14 (61%) as moderate and 5 (22%) as severe HIE. Of the 29 males and 14 females who received an amplitude EEG at 24 hours, 14% and 7% had seizures, respectively. 62 neonates had a full-scale EEG done within 24 hours with 21% males and 8% females with an abnormal EEG. Status epilepticus was observed in 14% (6/43) males and 9% (2/23) females. Of the 46 neonates who had their first brain MRI after rewarming, 35% of the males and 33% of the females had an abnormal MRI. Detailed analysis of MRI injury scoring of the infants with abnormal MRI will reveal the severity of injury as well as the specific locations that may be more susceptible to injury within a given sex.

Conclusion: The preliminary data thus far demonstrates that male neonates are more susceptible to seizures compared to female neonates. Further analysis of the available data is ongoing for the detailed assessment of brain MRI at birth and neurodevelopmental outcome measures.