Ambalavanan et al developed scores for predicting the outcome in a neonate with hypoxic-ischemic encephalopathy. This can help identify an infant who requires more aggressive management. The authors are from multiple universities in the United States participating in the National Institute of Child Health and Human Development Neonatal Research Network.
Outcome scores:
(1) death or disability
(2) death
Parameters for death or disability:
(1) posture
(2) spontaneous activity
(3) base deficit on first postnatal blood gas analysis (acidosis)
(4) Apgar score at 5 minutes
(5) chronic hypertension, pre-eclampsia, and/or eclampsia in mother
Parameters for death:
(1) posture
(2) base deficit on first postnatal blood gas analysis (acidosis)
(3) suck
(4) antepartum hemorrhage
|
Parameter |
Findings |
Points for Death or Disability |
Points for Death |
|
posture |
normal |
1 |
1 |
|
|
distal flexion |
11 |
9 |
|
|
decerebrate |
27 |
9 |
|
spontaneous activity |
normal |
1 |
0 |
|
|
decreased |
1 |
0 |
|
|
none |
7 |
0 |
|
base deficit |
< 15 mmol/L |
1 |
1 |
|
|
15 - 22 mmol/L |
4 |
4 |
|
|
> 22 mmol/L |
14 |
15 |
|
Apgar score at 5 minutes |
7 - 10 |
1 |
0 |
|
|
4 - 6 |
8 |
0 |
|
|
0 -3 |
12 |
0 |
|
maternal blood pressure |
no |
5 |
0 |
|
|
yes |
1 |
0 |
|
suck |
normal |
0 |
1 |
|
|
weak |
0 |
1 |
|
|
absent |
0 |
5 |
|
antepartum hemorrhage |
no |
0 |
2 |
|
|
yes |
0 |
1 |
total score for disability or death =
= SUM(points for the 5 parameters)
total score for death =
= SUM(points for the 4 parameters)
Interpretation:
• minimum scores: 0
• maximum score for death or disability: 65
• maximum score for death: 31
• The optimum cutoff for the death or disability score was>= 33.
• The optimum cutoff for the death score was>= 18.
Performance:
• The sensitivity of the death and disability score for the entire cohort was 84% and 70%.
• The sensitivity of the death score for the entire cohort was 76% and 69%.
Specialty: Neurology, Pedatrics
