Concerning Rising Trends of Hypoxic Ischemic Encephalopathy among Infants in the United States: 17-year analysis
Javeria Javeid1, Wajeeh Hassan1, Mehmood Akhtar2, Muzamil Akhtar3, Danish Ashraf4, Muhammad Saim5, Muhammad Shehryar Hussain1, Momna Nisar1, Syed Inam6, James Issa7
1Allama Iqbal Medical College, Jinnah Hospital, 2Bolan Medical College, 3Gujranwala Medical College, 4Foundation University Medical College, 5Mass General Brigham, 6Neurology, Marshall Neurology, 7Marshall University School of Medicine
Objective:
To evaluate the mortality trends of hypoxic-ischemic encephalopathy (HIE) stratified by infant age groups, sex, race, and region among infants in the United States (US) from 2006 to 2022.
Background:
Hypoxic-ischemic encephalopathy is one of the most common causes of morbidity and mortality among infants. Their mortality trends have not been examined at the general population level in the United States.
Design/Methods:
We analyzed the Centers for Disease Control and Prevention's Wide ranging Online Data for Epidemiologic Research (CDC WONDER)) for death certificates (2006-2022) of infants < 1 year of age, with HIE. Crude rates (CR) per 100,000 and annual percent change (APC) with 95% confidence intervals were calculated through joint-point regression analysis.
Results:
Between 2006 and 2022, a total of 6,630 deaths attributed to HIE were reported among infants in the US. The crude rate increased from 6.1 in 2006 to 14.8 in 2022 [APC = 5.2* 95% CI: 4.4-6.2], a percentage change of 143%. Males (10.5; APC=4.98* 95% CI: 4.2-5.9) had a higher CR than females (9.6; APC=5.54* 95% CI: 4.5-6.8). Among infant age groups, neonates aged 1-6 days had 8 times the CR as infants aged 28-364 days [<1 day=1.13; 1-6 days= 5.22; 7-27 days= 2.91; 28-364 days= 0.63]. Crude rates varied by race [Non-Hispanic (NH) African Americans=13.5; NH Whites=10.5; and Hispanics=7.4] and region [Midwest=10.7; West=10.3; South=9.9; Northeast=8.9]. States above the 90th percentile were Iowa, North Dakota, Indiana, Maine, and Utah.
Conclusions:
HIE-related mortality has been increasing continuously since 2006, especially among NH Blacks, male infants, and in the 1-6 days age group. Interventions, including skilled birth attendants at delivery, newborn resuscitation training for healthcare personnel, and identification of high-risk groups are necessary to reduce the burden of HIE.
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