Clinical signs predict 30-month neurodevelopmental outcome after neonatal encephalopathy

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Abstract

Objective

This study was undertaken to determine the value of a neonatal encephalopathy score (ES) and the presence of seizures for predicting 30-month neurodevelopmental outcome.

Study design

In a cohort study, 68 term newborn infants with encephalopathy were evaluated with an ES based on alertness, feeding, tone, respiratory status, reflexes, and seizure activity (range: 0-6). Seizures were noted as present or absent clinically. Significant cognitive deficits (Mental Development Index <70), motor disability (spastic triplegia/quadriplegia), or death were abnormal outcomes.

Results

Twenty-two newborn infants (32%) had abnormal outcomes. With the use of maximum ES and presence of seizures from days 1 to 3 of life, 87% of newborn infants were correctly classified (area under receiver operating curve 0.93). By using ES and presence of seizures on day 1 only, 87% of newborn infants were correctly classified (area under receiver operating curve 0.89).

Conclusion

The severity of neonatal encephalopathy and the presence of seizures are valuable predictors of 30-month neurodevelopmental outcome, as early as the first day of life.

Section snippets

Methods

Sixty-eight infants enrolled in a prospective cohort study of neonatal encephalopathy and monitored to 30 months of age are reported here. This cohort was derived from screening 5389 consecutive term neonates born in or transferred to our institution's intensive care nursery from 1994 to 2000.19 The inclusion criteria for this cohort were as follows: (1) umbilical artery pH less than 7.1, (2) umbilical artery base deficit greater than 10, or (3) 5-minute Apgar score ≤5. These broad criteria for

Results

At 30 months of age, 22 newborn infants (32%) were abnormal, including 8 newborn infants who died (12%). In this cohort, five deaths occurred in the neonatal period, two before 1 year of age and one before the 30-month follow-up visit; the cause of death was withdrawal of support in the neonatal period in 2 newborn infants. Of newborn infants classified as abnormal, the median MDI was 50 (range 50-84), and the median NMS was 5 (range 1-6), whereas in those classified as normal, the median MDI

Comment

The severity of neonatal encephalopathy together with the presence of clinical seizures are powerful predictors of 30-month outcome after neonatal encephalopathy. This is consistent with the findings of a recent meta-analysis, in which the strongest clinical predictor of neonatal death and cerebral palsy was the severity of neonatal encephalopathy.12 Many of the earlier neonatal encephalopathy classifications had prognostic value only when considered over the first 7 days of life.9., 11.

Acknowledgements

We thank Valencia J. Booth, MD, Laura E. Meeks, MD, Jennifer Weiss, MD, and Dev Puri, MD, for the development of the Encephalopathy Score and initial data collection. We also thank the neonatal nurses of the Pediatric Clinical Research Center for their work on this study.

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