To investigate racial disparities in the prevalence, severity, intervention, and outcomes of hypoxic-ischemic encephalopathy (HIE) among neonates in the United States.

We analyzed data from the National Inpatient Sample (NIS) dataset, including full-term infants diagnosed with HIE from 2010 to 2018. Regression analysis was performed to control for clinical and demographic variables.

Out of 31,249,100 infants, 23,475 (0.09%) were diagnosed with HIE. African American neonates had a 60% higher likelihood of developing HIE compared to Caucasians, adjusted odds ratio (aOR) 1.60 (1.52–1.69, p < 0.001), and were twice as likely to experience severe HIE, aOR 2.06 (1.77–2.39, p < 0.001). Overall mortality was significantly higher among African American infants, aOR 2.14, (2.02–2.26, p < 0.001). Mortality within HIE infants did not differ between African American and Caucasian infants aOR 0.88 (0.78–1.0), p < 0.61. Native American infants had a significantly lower chance of receiving hypothermia therapy compared to Caucasian infants, aOR 0.48 (0.29–0.77), p = 0.002.

Racial disparity exists in the prevalence, severity, and management of HIE. African Americans experience a higher prevalence and severity of HIE. Native Americans are less likely to receive hypothermia therapy for HIE.