Clinical signs predict 30-month neurodevelopmental outcome after neonatal encephalopathy☆
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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This study was carried out in part in the Pediatric Clinical Research Center, Moffitt Hospital, University of California, San Francisco, with funds provided by the National Center for Research Resources, grant No. 5 M01 RR-01271, US Public Health Service, by National Institutes of Health grant No. NS35902, and the Canadian Institutes of Health Research.