Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy predicts neurodevelopmental outcome at 18–24 months

Abstract

ObjectivesTo evaluate the association of short-term neurological improvement until day of life 4 in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) with neurodevelopmental outcome at 18–24 months.MethodsThis is a retrospective analysis of prospectively collected data of 174 neonates with HIE registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2013. TH was initiated according to national guidelines, and Sarnat staging was performed daily. Short-term neurological improvement was defined if Sarnat stage improved from admission until day 4 of life. Standardized neurodevelopmental assessments were performed at 18–24 months. Unfavorable outcome was defined as death before 2 years of age or severe or moderate disability at follow-up.ResultsOne hundred and sixty-four of 174 neonates (94%) received TH, of those 30 (18%) died in the neonatal period (no late mortality). Eighty-one percent of the survivors (109/134) were seen at 18–24 months. Of the 164 cooled neonates, 62% had a short-term neurological improvement, and the Sarnat score remained unchanged in 33%. Short-term neurological improvement was associated with an odds ratio (OR) of 0.118 [95% confidence interval (CI) 0.051–0.271] for an unfavorable outcome at 18–24 months.ConclusionShort-term neurological improvement predicts neurodevelopmental outcome at 18–24 months in the era of TH. Clinical examination must be part of a comprehensive evaluation for prognostication in HIE.

Implications of the HELIX trial for treating infants with hypoxic-ischaemic encephalopathy in low-to-middle-income countries

“…These data suggest that therapeutic hypothermia was most beneficial in a subset of infants who were larger and more likely to have had acute complications during labour rather than infants who were smaller and more likely to have had repetitive hypoxic insults in labour 10. Consistent with this interpretation, a recent study showed that perinatal sentinel events were associated with less severe brain injury on MRI after treatment with therapeutic hypothermia, and improved motor and language outcomes at 18–36 months 11…”

Prognostic Neurobiomarkers in Neonatal Encephalopathy

“…SS is the predominant tool for infant qualification for TH [14], whereas the TS is popular in resource-limited settings, and used as adjunct to SS to confirm NE grading or as a qualifying factor for TH [15, 16]. Short-term improvement in SS or TS are predictive of long-term outcomes [17, 18], and efforts are being made to further refine SS criteria [6].…”

Hypothermia after Perinatal Asphyxia Does Not Affect Genes Responsible for Amyloid Production in Neonatal Peripheral Lymphocytes

“…About 15–25% of these newborns die in the neonatal period, up to 25% of survivors develop neurological deficits, and 10–30% have retarded psychomotor development [ 4 , 5 ]. Studies analyzing the long-term consequences in preschool children after perinatal asphyxia have shown that cerebral palsy develops in 5.5–52% [ 6 , 7 , 8 , 9 ], severe disability in 11–19% [ 6 ], various motor impairments in 1.3–40% [ 2 , 8 , 9 , 10 ], hearing loss in 2–20% [ 6 , 9 , 10 ], vision defects in 1.8–40% [ 6 , 9 , 11 ], speech disorders in 4.2–21% [ 6 , 7 , 8 ], epilepsy in 13%, and cognitive impairment in 31% [ 1 , 2 , 12 ].…”