Survivors with bad outcome after hypoxic-ischaemic encephalopathy: full-term neonates compare unfavourably with children

Hypoxic-ischaemic encephalopathy (HIE) is of major importance in neonatal a nd paediatric intensive care with regard to mortality and long-term morbidi ty. Our aim was to analyse our data in full-term neonates and children with special regard to withdrawal of life support and had outcome. Patients: All patients with HIE admitted to our unit from 1992-96 were anal ysed. Criteria for HIE were presence of a hypoxic insult followed bq coma o r altered consciousness with or without convulsions. Severity of HIE was as sessed in neonates using Sarnat stages, and in children the duration of com a. In the majority of cases staging was completed with electrophysiological studies. Outcome was described using the Glasgow Outcome Scale. Bad outcom e was defined as death, permanent vegetative state or severe disability goo d outcome as moderate disability or good recovery. Results: In the neonatal group (n = 38) outcome was significantly associate d with Sarnat stages, presence of convulsions, severely abnormal EEG, cardi ovascular failure, and multiple organ dysfunction (MOD). A bad outcome was observed in 27 cases with 14 deaths and 13 survivors. Supportive treatment was withdrawn in 14 cases with 9 subsequent deaths. In the older age group (n = 45) outcome was related to persistent coma of 24-48 h, severely abnorm al EEG, cardiovascular failure, liver dysfunction and MOD. A bad outcome wa s found in 36 cases with 33 deaths and 3 survivors. Supportive treatment wa s withdrawn in 15 instances, all followed by death. Conclusions: Overall, neonates and older patients did not differ with regar d to good or bad outcome. However, in the neonatal group there were signifi cantly more survivors with bad outcome, either overall or after withdraw al of support. Possible explanations for this difference include variability of hypoxic insult, maturational and metabolic differences, and the more com pliant neonatal skull, which prevents brainstem herniation.