title: Therapeutic hypothermia changes the prognostic value of clinical evaluation of neonatal encephalopathy.
abstract: OBJECTIVE
  To evaluate whether therapeutic hypothermia alters the prognostic value of clinical grading of neonatal encephalopathy.
  
  
  METHODS
  This study was a secondary analysis of a multicenter study of 234 term infants with neonatal encephalopathy randomized to head cooling for 72 hours starting within 6 hours of birth, with rectal temperature maintained at 34.5 degrees C +/- 0.5 degrees C, followed by re-warming for 4 hours, or standard care at 37.0 degrees C +/- 0.5 degrees C. Severity of encephalopathy was measured pre-randomization and on day 4, after re-warming, in 177 infants; 31 infants died before day 4, and data were missing for 10 infants. The primary outcome was death or severe disability at 18 months of age.
  
  
  RESULTS
  Milder pre-randomization encephalopathy, greater improvement in encephalopathy from randomization to day 4, and cooling were associated with favorable outcome in multivariate binary logistic regression. Hypothermia did not affect severity of encephalopathy at day 4, however, in infants with moderate encephalopathy at day 4, those treated with hypothermia had a significantly higher rate of favorable outcome (31/45 infants, 69%, P = .006) compared with standard care (12/33, 36%).
  
  
  CONCLUSIONS
  Infants with moderate encephalopathy on day 4 may have a more favorable prognosis after hypothermia treatment than expected after standard care.
authors.affiliation: Department of Physiology, University of Auckland, Auckland, New Zealand. aj.gunn@auckland.ac.nz
authors.forename: Alistair J
authors.initials: AJ
authors.lastname: Gunn
authors.forename: John S
authors.initials: JS
authors.lastname: Wyatt
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.forename: John
authors.initials: J
authors.lastname: Barks
authors.forename: Denis
authors.initials: D
authors.lastname: Azzopardi
authors.forename: Roberta
authors.initials: R
authors.lastname: Ballard
authors.forename: A David
authors.initials: AD
authors.lastname: Edwards
authors.forename: Donna M
authors.initials: DM
authors.lastname: Ferriero
authors.forename: Peter D
authors.initials: PD
authors.lastname: Gluckman
authors.forename: Richard A
authors.initials: RA
authors.lastname: Polin
authors.forename: Charlene M
authors.initials: CM
authors.lastname: Robertson
authors.forename: Marianne
authors.initials: M
authors.lastname: Thoresen
mesh_terms: D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000628:therapy*; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome