Association of the neonatal sequential organ failure assessment score with neurological outcomes in infants diagnosed with hypoxic-ischemic encephalopathy.

Introduction: Early identification of neurodevelopmental impairment (NDI) risk in neonates with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH) may enable more precise care and improved outcomes. Methods: This was an exploratory, single-center, retrospective cohort study that included inborn infants admitted from January 2012- March 2023 with a diagnosis of HIE, who received TH within 6 hours of life and underwent a Weeke-scored brain MRI. Hourly neonatal sequential organ failure assessment (nSOFA) scores and laboratory maximum and minimum values were calculated using raw data. Results: Among 122 infants, 36 (29.5%) had an abnormal MRI (Weeke score ≥5). Bayley-III testing performed at ≥12 months of age was available for 66 infants, of whom 23 (34.8%) met criteria for NDI (any domain composite score <85). Models using laboratory values and the maximum nSOFA yielded good predictive accuracy for both an abnormal Weeke score (AUROC 0.79, 95% CI 0.70-0.88; NPV 81%, PPV 74%) and NDI (AUROC 0.78, 95% CI 0.66-0.89; NPV 78%, PPV 75%). Discussion: Early physiologic and laboratory measures predicted both MRI-defined injury and NDI, suggesting that early illness severity reflects underlying injury processes across outcome domains. Integration of these measures may support more precise risk stratification and prognostic assessment in infants with HIE.