Takeaway
- Among infants with neonatal hypoxic-ischemic encephalopathy (HIE), 2 models enabled good prediction of death or neurodevelopmental impairment as early as the first few hours of life.
Why this matters
- Reliable prediction may help target early therapies for those at highest risk.
Key results
- 49.8% of infants had the primary outcome of death or neurodevelopmental impairment:
- 37.0% died.
- 12.8% had neurodevelopmental impairment.
- Model components:
- Early model (data obtained around neonatal ICU admission):
- HIE severity;
- Epinephrine administration in delivery room;
- Respiratory support at admission; and
- Fraction of inspired oxygen of 0.21 at admission.
- Cumulative model (data obtained throughout hospitalization) included above with modifications, additions:
- Combined severity variable (EEG findings at 24 hours plus HIE severity);
- Steroids for BP management; and
- Significant brain injury on MRI.
- Early model (data obtained around neonatal ICU admission):
- Discovery models had high areas under the curve:
- 0.852 for early model.
- 0.861 for cumulative model.
- In validation cohort, goodness-of-fit χ2:
- P=.236 for early model.
- P=.060 for cumulative model.
Study design
- US multicenter, retrospective cohort study (Children’s Hospitals Neonatal Consortium Database, 2010-2016).
- 486 infants born ≥35 weeks of gestation, treated with therapeutic hypothermia for HIE.
- Main outcome: death or neurodevelopmental impairment (Bayley Scales of Infant Development score, deafness, blindness, gross motor delay) at ≥11 months.
- Funding: None.
Limitations
- Composite outcome.
- Unmeasured, residual confounding.
- Infants lacking neurodevelopmental follow-up were excluded.
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