Multi-organ dysfunction scoring in neonatal encephalopathy (MODE Score) and neurodevelopmental outcomes

Area of Science:

• Neonatal Medicine
• Pediatric Neurology
• Critical Care

Background:

• Neonatal encephalopathy (NE) poses a significant risk for multi-organ injury.
• Standardized definitions for multi-organ dysfunction in NE are lacking, impeding accurate assessment.
• Early identification of organ dysfunction is crucial for timely intervention and improved outcomes.

Purpose of the Study:

• To develop and validate a simple scoring system, the Multi-Organ Dysfunction in Neonatal Encephalopathy (MODE) score, for quantifying multi-organ injury.
• To assess the correlation between the MODE score and the severity of NE.
• To evaluate the predictive value of the MODE score for mortality and long-term neurodevelopmental outcomes.

Main Methods:

• A scoring system (MODE) was created, assessing cardiovascular, respiratory, gastrointestinal, haematological, and neurological systems (max score 15).
• The MODE score was compared with NE severity grading and Bayley Scales of Infant Development (Bayley-III) at 2 years.
• Mortality and adverse outcomes (Bayley score <90 and/or abnormal MRI) were analyzed in relation to MODE scores.

Main Results:

• Higher MODE scores were significantly associated with moderate/severe NE (NE II/III) compared to mild NE (p < 0.001).
• The MODE score demonstrated high predictive accuracy for mortality (AUC 0.96, p = 0.002).
• Elevated MODE scores correlated with abnormal neurological exams at discharge and adverse Bayley-III scores (p = 0.001).

Conclusions:

• The MODE score provides a valuable tool for quantifying multi-organ injury in NE, aiding early management decisions.
• The MODE score's strong correlation with mortality and neurodevelopmental outcomes highlights its clinical utility.
• Future research could explore clinical biomarkers as surrogate endpoints, linking to long-term developmental follow-up in NE clinical trials.