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[Neurologic sequelae of hypoxic-ischemic encephalopathy]
J Figueras Aloy1, A Roca González, A López Santiveri
1Subdivisión de Pediatría, Hospital Clínico y Facultad de Medicina, Barcelona.
Insights
Key factors like neurological dysfunction severity, convulsions, hypotension, ventilation needs, and EEG alterations predict neurodevelopmental impairment in infants with hypoxic-ischemic encephalopathy (HIE). A predictive formula aids in assessing impairment risk.
Area of Science:
- Neonatal Neurology
- Developmental Pediatrics
- Clinical Neurophysiology
Context:
- Neonatal hypoxic-ischemic encephalopathy (HIE) is a significant cause of brain injury in newborns.
- Neurodevelopmental impairment following HIE can have lifelong consequences for affected children and their families.
- Early identification of risk factors is crucial for timely intervention and management.
Purpose:
- To identify critical factors predicting the occurrence and severity of neurodevelopmental impairment in term neonates following HIE.
- To develop a predictive model for assessing the likelihood of neurodevelopmental impairment post-HIE.
Summary:
- This study analyzed 111 term neonates with HIE, assessing neurological dysfunction, convulsions, hypotension, ventilation requirements, and EEG alterations.
- Factors such as HIE severity, convulsion intensity, hypotension, assisted ventilation, and EEG changes significantly influenced neurodevelopmental outcomes.
- A validated formula incorporating these factors demonstrated high accuracy (94.9%) in predicting neurodevelopmental impairment, with a sensitivity of 66.7% and specificity of 97.4%.
Impact:
- The findings provide clinicians with a valuable tool for predicting neurodevelopmental impairment in HIE survivors.
- Accurate risk stratification can guide personalized follow-up strategies and early therapeutic interventions.
- Improved prediction of outcomes can aid in resource allocation and support services for affected families.
Abstract:
The aim of this work was to determine the most important factors related to the appearance of neurodevelopmental impairment after neonatal hypoxic-ischemic encephalopathy (HIE). A total of 111 full-term neonates, affected by HIE and followed for at least 12 months, were studied. Three infants (2.8%) were severely impaired, 6 (5.6%) were moderately handicapped and 3 (2.8%) had mild impairment. The severity of neurological dysfunction (HIE: evaluated as 1 to 3 according to Amiel-Tison), the intensity of convulsions (CONVULS: 0 = not, 1 = only one, 2 = two or more, 3 = status), the presence of hypotension (HYPOTEN: 0 = no, 1 = yes), the need of assisted ventilation (VENTILO: 0 = no, 1 = yes) and the degree of the EEG's alteration (EEG: 0 to 3 according to Dreyfus-Brisac and Monod) were the factors that influenced both the appearance of neurodevelopmental impairment and its severity. On the other hand, umbilical artery pH, the scores of the Apgar tests, need of resuscitation and the presence of acute renal failure did not show any influence. By applying the formula [Discriminating value = 0.4116*HIE + 1.2470*CONVULS + 1.3699*HYPOTEN + 0.8263*VENTILO + 0.5155*EEGRN - 1.3471], a discriminating value of less than 2 predicts no neurodevelopmental impairment with a confidence limit of 95.9%, while a value greater than = 2 indicates a 80% probability of its manifestation. The sensitivity of this test is 66.7%, its specificity 97.4% and its accuracy 94.9%.