Hayakawa et al identified a number of factors associated with a poor outcome for infants with hypoxic-ischemic encephalopathy (HIE). These can help to identify infants who may require more aggressive management. The authors are from multiple universities in Japan.


Patient selection: infant with hypoxic-ischemic encephalopathy (HIE)


Risk factors for a poor outcome:

(1) not born at a perinatal center (“outborn”), either in a private clinic or home

(2) low Apgar score at 5 minutes (less than 7)

(3) therapy with epinephrine during resuscitation (presumably for hypotension)

(4) low cord blood pH (acidosis, median 6.97 for good outcome and 6.88 for poor)

(5) other abnormal laboratory findings

(6) abnormal brain MRI (bilateral basal ganglia thalamic lesions, parasagittal injury, subcortical leukomalacia, multicystic encephalomalacia, periventricular leukomalacia, intracranial hemorrhage)


Laboratory tests that tend to be higher with HIE:

(1) serum lactate

(2) serum LDH

(3) serum AST

(4) serum CK


The abnormal brain MRI was important for determining prognosis (odds ratio 11.6).


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