J. Pfenninger et al., Survivors with bad outcome after hypoxic-ischaemic encephalopathy: full-term neonates compare unfavourably with children, SWISS MED W, 131(19-20), 2001, pp. 267-272
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was withdrawn in 14 cases with 9 subsequent deaths.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s withdrawn in 15 instances, all followed by death.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.