Clinical predictors of outcome following mild and moderate neonatal encephalopathy in term newborns in Kathmandu, Nepal.
We describe a clinical grading system for the assessment of neonatal encephalopathy developed for a large prospective study in Kathmandu. Inter-observer variability  testing of our system on 27 infants showed high agreement (kappa value 0.87). Validity for the prediction of major neurodevelopmental impairment at 1 y of age was tested using a cohort of 57 survivors of encephalopathy, all of whom were assessed using a combination of the Denver Developmental Screening Test and Bailey 2 at 1 y. We compared this with a modification of a scoring system previously validated in Cape Town. Both schemes converted a pretest probability of 31% (the prevalence of major impairment at 1 y of age in this cohort) to a post-test probability of 55%. This showed only marginal improvement over the traditional risk marker of neurological abnormality at discharge (post-test probability 51%). At 6 wk of age acquired microcephaly increased the probability of major impairment to 79%.


CONCLUSIONS
It seems to make little difference both in practical or predictive terms whether one describes the neurological condition of the neonate using a descriptive or scoring system. The important thing is to perform repeated systematic neurological examinations on a daily basis during the neonatal period. Many clinicians will justifiably continue to use the discharge examination as the deciding factor for the need for continued neurodevelopmental surveillance.
Ellis
M
M
Centre for International Child Health, Institute of Child Health, University College, London, UK. M.Ellis@bristol.ac.uk
Shrestha
L
L
Shrestha
P S
PS
Manandhar
D S
DS
Bolam
A J
AJ
L Costello
A M
AM
D000886:Anthropometry; D001927:Brain Diseases / Q000503:physiopathology*; D003906:Developing Countries; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009390:Nepal / Q000453:epidemiology; D009460:Neurologic Examination; D015588:Observer Variation; D011336:Probability; D011379:Prognosis; D015203:Reproducibility of Results