The predictive value of early neurological examination in neonatal hypoxic–ischaemic encephalopathy and neurodevelopmental outcome at 24 months

Abstract

AIM The clinical and electrographic signs of hypoxic-ischaemic encephalopathy (HIE) evolve over the first days of life. We examined the evolution of neurological signs over the first 3 days of life, and determined whether serial administration of the Amiel-Tison Neurological Assessment at Term (ATNAT) would predict neurodevelopmental outcome at 24 months. METHOD Term (>37wks' gestation) neonates born with suspected HIE between May 2003 andMay 2005 in a Cork maternity unit were recruited prospectively. Modified Sarnat grading was assigned. The ATNAT was administered on days 1, 2, and 3 of life and a discharge neurological examination. Time to oral feeding and demographic variables were recorded. Developmental status was assessed using the revised Griffiths Mental Development Scales at 6, 12, and 24 months.RESULTS Fifty-seven infants were recruited, with 51 (31 males, 20 females) included for follow-up.Neurological examination evolved and normalized over the first 3 days of life in many cases. At 24 months, 21 children had an adverse outcome, including six deaths. Examination at all time points correlated significantly with neurological outcome at 24 months. The best correlations were found to be (1) neurological examination at discharge (r=0.65, p<0.001), (2) Sarnat grading (r=0.64, p<0.001), and (3) ATNAT on day 3 (r=0.46, p<0.001). The best predictive value was seen with neurological examination at discharge (positive and negative predictive values of 86% and 72% respectively).

Short-Term Outcomes of Newborns with Perinatal Acidemia Who are Not Eligible for Systemic Hypothermia Therapy

“…Abnormal short-term outcome was defined a priori as any one of the following: death, seizures, abnormal brain magnetic resonance imaging (MRI), abnormal neurologic examination at discharge as determined by the NICU provider, gastrostomy tube feeding, or inability to achieve full nipple feeds until after the first week of age and that required consultation by speech therapy. 14 One experienced pediatric neuroradiologist (M.M. ), who was blinded to the infant's clinical status, reviewed the MRI studies.…”

Neonatal Hypoxia Ischaemia: Mechanisms, Models, and Therapeutic Challenges

“…Infants who have suffered neonatal HI often exhibit abnormal EEG activity (reviewed in Walsh et al, 2011; van Laerhoven et al, 2013). A range of abnormalities have been described, including: low voltage in isoelectric EEG (Finer et al, 1983; Legido et al, 1991), mild voltage depression (Watanabe et al, 1980; Toet et al, 2002; Murray et al, 2010), and asymmetry of trace (Aso et al, 1989; Zeinstra et al, 2001; Murray et al, 2009), although all of these criteria have been differently defined by different analysts (Rennie et al, 2004; Shellhaas et al, 2007). However, imaging techniques are constantly improving.…”

Comparison of Bayley‐2 and Bayley‐3 scores at 18 months in term infants following neonatal encephalopathy and therapeutic hypothermia

“…However, in order to compare outcomes in neuroprotection trials, it is important to know how the two different editions of the test function in the range of moderate to severe delay. Furthermore, term infants with neonatal encephalopathy have a different spectrum of neurodevelopment with a high risk of severe motor and cognitive disability 17,18. In treatment trials where all infants have a high risk of developmental impairment, it is particularly important to know how assessments function in the range of moderate to severe delay (<70) as disability may not be prevented in all its grades, but may be lessened in severity with improved functional ability.…”