Combination of early perinatal factors to identify near-term and term neonates for neuroprotection.
OBJECTIVE
To determine early predictors of abnormal outcome at > or =24 months' age in neonates at risk for hypoxic-ischemic brain injury.


METHODS
A prospective cohort study with developmental follow-up of > or =24 months. Infants were selected based on risk factors, and neurologic outcome was determined. Variables affecting the outcome were evaluated with univariate and multivariate methods, and a scoring system was devised to predict adverse outcome.


RESULTS
A total of 41 infants born > or =35 weeks' gestational age with possibility of hypoxic-ischemic insult were enrolled. In all, 39 (95%) had known outcomes, of whom 17 (48%) had an abnormal neurologic outcome, including five deaths. The variables within the first hour of life correlating with the adverse outcome were 1- and 5-minute Apgar scores, intubation in the delivery room and cord/initial base-deficit > or =20 mmol/l. A scoring system was derived based on significant variables, and a score > or =5 had a 90% positive predictive value for abnormal outcome. Seizures, multiorgan failure and abnormal imaging studies were also significantly associated with abnormal outcome.


CONCLUSIONS
The proposed scoring system, being highly predictive of outcome at 24 months' age, may be potentially useful in selecting subjects for preventive or therapeutic interventions to prevent or minimize neurologic morbidity due to hypoxic brain injury.
Talati
Ajay J
AJ
Departments of Pediatrics and Obstetrics and Gynecology, The University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Yang
Wenjian
W
Yolton
Kimberly
K
Korones
Sheldon B
SB
Bada
Henrietta S
HS
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000150:complications*; D002585:Cesarean Section; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000209:etiology; D007231:Infant, Newborn; D009102:Multiple Organ Failure / Q000517:prevention & control; D015999:Multivariate Analysis; D015997:Neonatal Screening / Q000379:methods*; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D012640:Seizures / Q000517:prevention & control