Peeples et al reported predictors for the neurodevelopmental outcome following neonatal hypoxic-ischemic encephalopathy. The authors are from multiple Children's Hospitals in the United States.
Patient selection: gestation >= 35 weeks, diagnosis of perinatal HIE, treatment with therapeutic hypothermia and admission < 4 days after birth, without major congenital anomalies
Outcome: neurodevelopmental impairment (one or more of: Bayley Scale of Infant Development III composite cognitive score < 85; BSID-III composite motor score < 70; deafness; blindness; gross motor delay)
Predictors of neurodevelopmental impairment from multivariate analysis:
(1) (severe HIE) OR (abnormal amplitude-integrated EEG or continuous EEG findings at 24 hours) (OR 10.9)
(2) administration of epinephrine in the delivery room (OR 2.3)
(3) administration of steroids for blood pressure (OR 4.7)
(4) severe brain injury on MRI (OR 2.1)
where:
• Severe EEG findings = burst suppression, isoelectric or flat tracings
• Severe brain injury on MRI = deep gray injury and/or cortical injury
Protective factors:
(1) breathing room air (FIO2 0.21; no supplemental oxygen) on admission (OR 0.47)
(2) no respiratory support on admission (OR 0.45)
