Clinical predictors of outcome following mild and moderate neonatal encephalopathy in term newborns in Kathmandu, Nepal

We describe a clinical grading system for the assessment of neonatal enceph alopathy developed for a large prospective study in Kathmandu. Inter-observ er variability testing of our system on 27 infants showed high agreement (k appa value 0.87). Validity for the prediction of major neurodevelopmental i mpairment at 1 y of age was tested using a cohort of 57 survivors of enceph alopathy. all of whom were assessed using a combination of the Denver Devel opmental Screening Test and Bailey 2 at 1 y, We compared this with a modifi cation of a scoring system previously validated in Cape Town. Both schemes converted a pretest probability of 31% (the prevalence of major impairment at 1 y of age in this cohort) to a post-test probability of 55%. This showe d only marginal improvement over the traditional risk marker of neurologica l abnormality at discharge (post-test probability 51%). At 6 wk of age acqu ired microcephaly increased the probability of major impairment to 79%. Conclusions: It seems to make little difference both in practical or predic tive terms whether one describes the neurological condition of the neonate using a descriptive or scoring system. The important thing is to perform re peated systematic neurological examinations on a daily basis during the neo natal period, Many clinicians will justifiably continue to use the discharg e examination as the deciding factor for the need for continued neurodevelo pmental surveillance.