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Prolonged requirements for mechanical ventilation and tube feeding support predicted 18-month outcomes for neonatal

Kennosuke Tsuda1, Jun Shibasaki2, Akihito Takeuchi3

  • 1Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.

Acta Paediatrica (Oslo, Norway : 1992)
|January 28, 2023
PubMed

Insights

Prolonged mechanical ventilation or tube feeding support for over 14 days can predict 18-month outcomes in infants with hypoxic-ischaemic encephalopathy who received therapeutic hypothermia.

Area of Science:

  • Neonatalogy
  • Pediatric Neurology
  • Critical Care Medicine

Background:

  • Hypoxic-ischaemic encephalopathy (HIE) is a major cause of neonatal mortality and long-term neurological disability.
  • Therapeutic hypothermia is a standard treatment for HIE, but predicting long-term outcomes remains challenging.
  • Identifying reliable predictors of adverse outcomes is crucial for optimizing infant care and parental counseling.

Purpose of the Study:

  • To evaluate the predictive ability of prolonged mechanical ventilation or tube feeding support for 18-month composite outcomes in infants with HIE treated with hypothermia.
  • To determine the utility of specific durations of mechanical ventilation or tube feeding in predicting adverse outcomes.

Main Methods:

  • Retrospective, nationwide, observational study using data from Japan's Baby Cooling Registry (2012-2016).
  • Inclusion of newborn infants with HIE treated with therapeutic hypothermia.
  • Definition of adverse outcomes as death or survival with cerebral palsy, visual/auditory impairment, or need for mechanical ventilation/tube feeding at 18 months.

Main Results:

  • Adverse outcomes occurred in 28% of the 591 infants studied.
  • Prolonged dependence on mechanical ventilation or tube feeding for >7 days had a positive predictive value (PPV) of 0.34 (95% CI 0.33-0.34).
  • Dependence for >14 days showed a higher PPV of 0.60 (95% CI 0.56-0.62) and an area under the curve (AUC) of 0.81 (95% CI 0.77-0.85) for predicting 18-month outcomes.

Conclusions:

  • Prolonged dependence on mechanical ventilation or tube feeding for more than 14 days is a useful predictor of 18-month outcomes in HIE infants treated with therapeutic hypothermia.
  • This finding can aid in risk stratification and clinical decision-making for HIE management.
  • Further research may explore combining this predictor with other clinical or neuroimaging markers for enhanced predictive accuracy.
Abstract

Keywords:
hypoxic-ischaemic encephalopathyneurodevelopmental outcomeperinatal asphyxiaprolonged medical supporttherapeutic hypothermia

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