PREDICTING THE OUTCOME OF POSTASPHYXIAL HYPOXIC-ISCHEMIC ENCEPHALOPATHY WITHIN 4 HOURS OF BIRTH

Objective: To build models that predict severe adverse outcome within 4 hours of birth in patients with postasphyxial hypoxic-ischemic encep halopathy. The goal was to develop models for selecting patients for t herapeutic trials of neuroprotective medications. Study design: Retros pective cohort study with follow-up to a minimum age of 12 months of 1 64 ''outborn'' term infants admitted to a tertiary neonatal intensive care unit, and 14 ''inborn'' term infants in the two tertiary perinata l centers in a regionalized setting. After performing univariate scree ning tests, multivariate models of association between risk factors an d ''severe adverse outcome'' (death or major neurosensory impairment) were constructed. Results: Of 178 infants with postasphyxial hypoxic-i schemic encephalopathy of defined severity admitted consecutively betw een 1985 and 1992, 48 died, 40 survived with major neurosensory impair ment, and 13 were lost to follow-up. The important predictors of sever e adverse outcome in the first 4 hours were delayed onset of breathing , administration of chest compressions, and seizures. At 60 minutes of age, based on predicted probabilities of >0.50, the sensitivity of th e predictive model was 85% and specificity 68%. The parameter estimate s of the predictive models are reported. Conclusion: Age of onset of b reathing, administration of chest compressions, and age of onset of se izures were the most important variables predictive of adverse outcome in this study. Although fairly sensitive and specific, these predicti ve models should be applied with caution. To build more accurate model s, a template for the conduct of a large, multicenter prospective stud y is provided.