Can tissue oxygenation index (TOI) and cotside neurophysiological variables predict outcome in depressed/asphyxiated newborn infants?
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.
Zaramella
Patrizia
P
Department of Paediatrics, Neonatal Intensive Care Unit, University of Padova, Via Giustiniani, 3, 35128 Padova, Italy. zaramella@pediatria.unipd.it
Saraceni
Elisabetta
E
Freato
Federica
F
Falcon
Elena
E
Suppiej
Agnese
A
Milan
Anna
A
Laverda
Anna Maria
AM
Chiandetti
Lino
L
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
D010100:Oxygen