title: Predictors of neurological outcome in cooled neonates.
abstract: BACKGROUND
  We define clinical predictors of neurological outcome in neonates with hypoxic-ischemic encephalopathy undergoing hypothermia therapy.
  
  
  METHODS
  Twenty-one neonates who underwent selective head cooling between 2004 and 2010 and were followed neurologically for ≥ 24 months were investigated retrospectively. Patients were divided according to the neurological outcome at 2 years of age into group A (n = 11), patients with normal neurological function, and group B (n = 10), patients with neurological disabilities (n = 9) or those who died (n = 1). Predictors were determined by χ(2) and Mann-Whitney U-tests, anova, Spearman rank correlations and receiver-operator curves.
  
  
  RESULTS
  Group B showed higher average blood lactate levels during the first day, particularly at 24 h of life; lower day-3 cerebral blood flow resistance index; higher maximum dobutamine dose used; higher rate of thiamylal sodium used; more severe background electroencephalogram suppression during the first week (group A: 11/11 cases ≤ grade 3; group B: 7/9 cases at grade 4-5) and higher rate of cerebral lesions on magnetic resonance imaging in the second week (group A: 1/11 case; group B: 9/10 cases) than group A. The most useful predictor of poor prognosis was cerebral parenchymal lesions on magnetic resonance imaging with 90%, 90% and 90% of sensitivity, specificity and accuracy, followed by week-1 background electroencephalogram ≥ grade 4 with 70%, 100% and 85% and day-3 cerebral blood flow resistance index < 0.46 with 71%, 88% and 80%, respectively.
  
  
  CONCLUSIONS
  Prediction of post-cooling neurological outcome could be improved substantially by evaluating multiple factors.
authors.affiliation: Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan.
authors.forename: Jingang
authors.initials: J
authors.lastname: Li
authors.forename: Masahisa
authors.initials: M
authors.lastname: Funato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tamai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.forename: Masato
authors.initials: M
authors.lastname: Nishihara
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Iwamoto
authors.forename: Yoko
authors.initials: Y
authors.lastname: Okazaki
authors.forename: Haruo
authors.initials: H
authors.lastname: Shintaku
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006257:Head; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome