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Model of Shah et al for Predicting Probability of a Severe Outcome in a Neonate with Hypoxic-Ischemic Encephalopathy (HIE)

Purpose: To identify a newborn infant at risk for severe hypoxic ischemic encephalopathy following perinatal asphyxia based on the model of Shah et al.

Description

Shah et al identified risk factors associated with a severe outcome in neonates with hypoxic-ischemic encephalopathy (HIE). High risk infants can be identified within 4 hours of birth. The authors are from Mount Sinai Hospital, University of Toronto and the Hospital for Sick Children in Toronto.


Criteria for serious outcome:

(1) severe neurodevelopmental disability (any combination of cortical blindness, cerebral palsy, sensorineural deafness, severe developmental delay)

(2) death

 

Timing of evaluation: during the first 4 hours after delivery

 

Parameters:

(1) duration chest compression after delivery

(2) base deficit in mmol/L

(3) delay in onset of respirations after delivery (time between delivery and spontaneous breathing)

 

Parameter

Findings

Points

duration of chest compression

<= 1 minute

0

 

> 1 minute

1

base deficit (acidosis)

<= 16 mmol/L

0

 

> 16 mmol/L

1

delay in onset of respirations

< 30 minutes after birth

0

 

>= 30 minutes

1

 

total number of findings =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 3

• The higher the score the greater the risk of a serious outcome.

 

Total Score

Probability of a Serious Outcome

0

46%

1

64%

2

77%

3

93%

 

Performance (page 731):

• The sensitivity for a serious outcome was 73% with the specificity 89% (although I could not find what cutoff value was used).

• The area under the ROC curve was 0.74 which is fair.


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Specialty

Objective

ICD-10