Early predictors of adverse outcome in term infants with post-asphyxial hypoxic ischaemic encephalopathy.
A retrospective study of 35 term infants with post-asphyxial hypoxic-ischaemic encephalopathy (HIE) was conducted to identify early clinical predictors of either death or major motor disability at 18 mo of age. Twenty-three had severe adverse outcome:13 died and 10 had major neurological sequelae. The significant risk factors were a low 5 min Apgar score, use of adrenaline, low first arterial pH and high base deficit. A base deficit > or =20 mEq/L is a useful predictor of death or disability with a high positive predictive value (PPV) of 93.8%, followed by 93.3% and 84.2% for pH <7.1 and 5 min Apgar score <4, respectively. The PPV of death or disability is enhanced in the model combining base deficit of > or =20 mEq/L and 5 min Apgar score of <4. This model has a sensitivity of 66.7% and specificity of 100%. Severe metabolic acidosis of base deficit > or =25 mEq/L was associated with a high risk of dying: PPV 77.8% and specificity 88.9%.
Toh
V C
VC
Department of Neonatology, KK Women's and Children's Hospital, Singapore. corna@kkh.com.sg
D000142:Acidosis, Respiratory / Q000175:diagnosis / Q000209:etiology; D000704:Analysis of Variance; D001238:Asphyxia Neonatorum / Q000145:classification / Q000150:complications*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000145:classification* / Q000175:diagnosis / Q000209:etiology; D007231:Infant, Newborn; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors