Multi-organ dysfunction occurs in neonates with hypoxic ischemic neonatal encephalopathy. Sweetman et al reported the MODE score for evaluating a neonate with hypoxic ischemic neonatal encephalopathy. The authors are from multiple organizations and institutions in Dublin, Ireland.
Patient selection: neonate with perinatal asphyxia
Parameters:
(1) heart rate in beats per minute
(2) serum troponin T in ng/mL
(3) duration of mechanical ventilation in hours
(4) duration of oxygen requirement in hours
(5) serum AST in IU/L
(6) serum ALT in IU/L
(7) time to full oral feedings in days
(8) platelet count in 10^9/L
(9) PT time in seconds
(10) plasma fibrinogen in g/L
(11) urine output in mL per kg per hour
(12) serum creatinine in µmol/L
(13) cranial ultrasound
(14) cranial MRI
(15) clinical seizures
(16) seizure activity on EEG
|
Parameter |
Finding |
Points |
|
heart rate |
< 80 beats per minute |
1 |
|
|
>= 80 beats per minute |
0 |
|
serum troponin |
<= 0.1 ng/mL |
0 |
|
|
> 0.1 ng/mL |
1 |
|
mechanical ventilation |
<= 72 days |
0 |
|
|
> 72 days |
1 |
|
oxygen requirement |
<= 72 hours |
0 |
|
|
> 72 hours |
1 |
|
serum AST |
<= 100 U/L |
0 |
|
|
> 100 U/L |
1 |
|
serum ALT |
<= 100 U/L |
0 |
|
|
> 100 U/L |
1 |
|
time to full oral feedings |
< 6 days |
0 |
|
|
>= 6 days |
1 |
|
platelet count |
>= 60 * 10^9/L |
0 |
|
|
< 60 * 10^9/L |
1 |
|
PT |
<= 20 seconds |
0 |
|
|
> 20 seconds |
1 |
|
plasma fibrinogen |
< 1 g/L |
1 |
|
|
>= 1 g/L |
0 |
|
urine output |
< 1 mL per kg per hour |
1 |
|
|
>= 1 mL per kg per hour |
0 |
|
serum creatinine |
<= 100 µmol/L |
0 |
|
|
> 100 µmol/L |
1 |
|
cranial ultrasound |
normal |
0 |
|
|
abnormal |
1 |
|
cranial MRI |
normal |
0 |
|
|
abnormal |
1 |
|
clinical seizures |
no |
0 |
|
|
yes |
1 |
|
EEG |
normal |
0 |
|
|
seizures |
1 |
where:
• The handling of the seizures on EEG was not clear.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 15 or 16. The value of 16 is for the modified score with inclusion of EEG (see also footnote to Figure 1)
• A score > 10.5 was associated with mortality.
• Survivors with normal neurological outcomes had a score <= 5.
Performance:
• The score had an area under the ROC curve of 0.96 for mortality.
Specialty: Neurology
