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Published on: October 28, 2022
Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy predicts neurodevelopmental
Beate Grass1, Simone Scheidegger1, Beatrice Latal2
1Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) predicts long-term neurodevelopmental outcomes. Early clinical assessment is crucial for prognostication in HIE.
Area of Science:
- Neonatal neurology
- Perinatal medicine
- Neurodevelopmental outcomes
Background:
- Hypoxic-ischemic encephalopathy (HIE) is a serious condition in newborns.
- Therapeutic hypothermia (TH) is a standard treatment for HIE.
- Predicting long-term outcomes in HIE is critical for clinical management.
Purpose of the Study:
- To assess the association between early neurological improvement and long-term neurodevelopmental outcomes in neonates with HIE treated with TH.
- To determine the predictive value of short-term neurological status for HIE survivors.
Main Methods:
- Retrospective analysis of prospectively collected data from 174 neonates with HIE.
- Therapeutic hypothermia (TH) initiated per national guidelines.
- Daily Sarnat staging for neurological assessment until day 4.
- Neurodevelopmental assessments at 18-24 months; unfavorable outcome defined as death or disability.
Main Results:
- 62% of neonates receiving TH showed short-term neurological improvement.
- Short-term neurological improvement was strongly associated with a significantly lower risk of unfavorable neurodevelopmental outcome (OR 0.118).
- No late mortality observed; 81% of survivors were assessed at follow-up.
Conclusions:
- Early neurological improvement within the first four days of life is a significant predictor of favorable neurodevelopmental outcomes in neonates with HIE treated with TH.
- Clinical examination, specifically Sarnat staging, is a vital component of comprehensive prognostication for HIE.
Abstract:
Objectives To evaluate the association of short-term neurological improvement until day of life 4 in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) with neurodevelopmental outcome at 18-24 months. Methods This is a retrospective analysis of prospectively collected data of 174 neonates with HIE registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2013. TH was initiated according to national guidelines, and Sarnat staging was performed daily. Short-term neurological improvement was defined if Sarnat stage improved from admission until day 4 of life. Standardized neurodevelopmental assessments were performed at 18-24 months. Unfavorable outcome was defined as death before 2 years of age or severe or moderate disability at follow-up. Results One hundred and sixty-four of 174 neonates (94%) received TH, of those 30 (18%) died in the neonatal period (no late mortality). Eighty-one percent of the survivors (109/134) were seen at 18-24 months. Of the 164 cooled neonates, 62% had a short-term neurological improvement, and the Sarnat score remained unchanged in 33%. Short-term neurological improvement was associated with an odds ratio (OR) of 0.118 [95% confidence interval (CI) 0.051-0.271] for an unfavorable outcome at 18-24 months. Conclusion Short-term neurological improvement predicts neurodevelopmental outcome at 18-24 months in the era of TH. Clinical examination must be part of a comprehensive evaluation for prognostication in HIE.
