title: Can tissue oxygenation index (TOI) and cotside neurophysiological variables predict outcome in depressed/asphyxiated newborn infants?
abstract: BACKGROUND
  Diagnostic tools of birth asphyxia provide only an uncertain prediction of neurological outcome.
  
  
  OBJECTIVE
  To assess whether TOI and DeltaCBV, combined with a set of biochemical and neurophysiological variables, have any diagnostic and prognostic value in birth depression or asphyxia.
  
  
  METHODS
  Case control study at the nursery and NICU of the Padova University Children's Hospital.
  
  
  METHODS
  22 term neonates with an Apgar score < or = 6 at 5', a 1-h umbilical artery pH value < or = 7.25 with an increased base deficit and a gestational age > or = 36 weeks; 15 healthy term infants with an Apgar score > or = 9 at 5'.
  
  
  METHODS
  Troponin I and NIRS measurements (TOI and DeltaCBV) were assessed in both groups. Blood gases, neurological evaluation, US, NIRS, EEG and SEP were evaluated in the infants with depression or asphyxia.
  
  
  RESULTS
  Troponin I was higher in the study group than in controls (p=0.04), showing a correlation with base excess values. In the depressed/asphyxiated neonates with an abnormal outcome at 1 year, TOI rose to 80.1% vs 66.4% in controls (p=0.04) and 74.7% in infants with a normal 1-year outcome. A multiple regression model showed a significant multiple correlation coefficient, R=0.79, p<0.001, where the predictive variables significantly associated with outcome were SEP and BE.
  
  
  CONCLUSIONS
  Troponin I is a useful short-term index of birth asphyxia or perinatal depression. An increased TOI suggests a risk of abnormal neurological outcome at 1 year. Among the cotside variables, BE and evoked potential abnormalities were the best predictors of abnormal outcome in this study.
authors.affiliation: Department of Paediatrics, Neonatal Intensive Care Unit, University of Padova, Via Giustiniani, 3, 35128 Padova, Italy. zaramella@pediatria.unipd.it
authors.forename: Patrizia
authors.initials: P
authors.lastname: Zaramella
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Saraceni
authors.forename: Federica
authors.initials: F
authors.lastname: Freato
authors.forename: Elena
authors.initials: E
authors.lastname: Falcon
authors.forename: Agnese
authors.initials: A
authors.lastname: Suppiej
authors.forename: Anna
authors.initials: A
authors.lastname: Milan
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Laverda
authors.forename: Lino
authors.initials: L
authors.lastname: Chiandetti
mesh_terms: D001238:Asphyxia Neonatorum / Q000175:diagnosis* / Q000378:metabolism*; D016022:Case-Control Studies; D006801:Humans; D007231:Infant, Newborn; D009424:Nervous System Physiological Phenomena; D010100:Oxygen / Q000378:metabolism*; D011379:Prognosis
chemical_list: D010100:Oxygen