Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy predicts neurodevelopmental outcome at 18–24 months

Beate Grass; Simone Scheidegger; Beatrice Latal; Cornelia Hagmann; Ulrike Held; Barbara Brotschi; National Asphyxia and Cooling Register Group and Follow-up Group

doi:10.1515/jpm-2019-0391

Article

Short-term neurological improvement in neonates with hypoxic-ischemic encephalopathy predicts neurodevelopmental outcome at 18–24 months

Beate Grass , Simone Scheidegger , Beatrice Latal , Cornelia Hagmann , Ulrike Held , Barbara Brotschi and National Asphyxia and Cooling Register Group and Follow-up Group

Published/Copyright: February 18, 2020

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From the journal Journal of Perinatal Medicine Volume 48 Issue 3

Abstract

Objectives

To evaluate the association of short-term neurological improvement until day of life 4 in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) with neurodevelopmental outcome at 18–24 months.

Methods

This is a retrospective analysis of prospectively collected data of 174 neonates with HIE registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2013. TH was initiated according to national guidelines, and Sarnat staging was performed daily. Short-term neurological improvement was defined if Sarnat stage improved from admission until day 4 of life. Standardized neurodevelopmental assessments were performed at 18–24 months. Unfavorable outcome was defined as death before 2 years of age or severe or moderate disability at follow-up.

Results

One hundred and sixty-four of 174 neonates (94%) received TH, of those 30 (18%) died in the neonatal period (no late mortality). Eighty-one percent of the survivors (109/134) were seen at 18–24 months. Of the 164 cooled neonates, 62% had a short-term neurological improvement, and the Sarnat score remained unchanged in 33%. Short-term neurological improvement was associated with an odds ratio (OR) of 0.118 [95% confidence interval (CI) 0.051–0.271] for an unfavorable outcome at 18–24 months.

Conclusion

Short-term neurological improvement predicts neurodevelopmental outcome at 18–24 months in the era of TH. Clinical examination must be part of a comprehensive evaluation for prognostication in HIE.

Keywords: hypoxic-ischemic encephalopathy; neurodevelopmental outcome; prognostication

Corresponding author: Beate Grass, MD, Department of Pediatric and Neonatal Intensive Care, University Children’s Hospital Zurich, Steinwiesstr. 75, 8032 Zurich, Switzerland, Phone: +41 44 266 3765, Fax: +41 44 266 7168

Author contributions: BG and BB conceived and designed the study. BG was responsible for acquisition of data, data analysis and interpretation, search and review of literature and drafting of the manuscript. SS helped with the acquisition of data, data analysis and critical review of the manuscript. UH performed all statistical analyses of the study, interpreted the results and critically revised the manuscript. BB, BL and CH supervised the design of the study, data analysis and interpretation, search and review of literature and critical review of the manuscript. All authors have read and approved the final manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Collaborators: The National Asphyxia and Cooling Register Group: Aarau: Cantonal Hospital Aarau, Children’s Clinic, Department of Neonatology (G. Zeilinger); Basel: University Children’s Hospital Basel (UKBB), Department of Neonatology (S.M. Schulzke, S.Wellmann); Berne: University Hospital Berne, Department of Pediatric Intensive Care (B. Wagner, K. Daetwyler); Chur: Children’s Hospital Chur, Department of Neonatology (W. Bär, B.Scharrer); Lausanne: University Hospital (CHUV), Department of Neonatology (J.-F. Tolsa, A. Truttmann, J. Schneider); Geneva: University Hospital (HUG), Division of Neonatology (R. E. Pfister); Lucerne: Children’s Hospital of Lucerne, Neonatal and Pediatric Intensive Care Unit (T. M. Berger, M. Fontana); St.Gallen: Children’s Hospital St. Gallen, Neonatal and Pediatric Intensive Care Unit (J. P. Micallef, I. Hoigné); Zurich: University Hospital Zurich (3), Department of Neonatology (D. Bassler, G. Natalucci, M. Adams); and University Children’s Hospital Zurich, Department of Intensive Care and Neonatology (B. Frey, V. Bernet).
Follow-Up Group: Aarau: Cantonal Hospital Aarau, Children’s Clinic, Department of Neuropaediatrics (A. Capone Mori, D. Kaeppeli); Basel: University of Basel Children’s Hospital (UKBB), Department of Neuropaediatrics and Developmental Medicine (P. Weber, M. Brotzmann); Bellinzona: San Giovanni Hospital, Department of Paediatrics (G.P. Ramelli, B. Goeggel Simonetti); Berne: University Hospital Berne, Department of Neuropaediatrics (M. Steinlin, S. Grunt); Biel: Children’s Hospital Wildermeth, Development and Paediatric Neurorehabilitation Center (R. Hassink); Chur: Children’s Hospital Chur, Department of Neuropaediatrics (E. Keller, Ch. Killer); Fribourg: Cantonal Hospital Fribourg, Department of Neuropaediatrics (K. Fuhrer); Geneva: Department of Child and Adolescent, University Hospital (HUG), Division of Development and Growth (P. S. Hüppi); Lausanne: University Hospital (CHUV), Department of Child Development (M. Bickle-Graz, A. Torregossa); Lucerne: Children’s Hospital of Lucerne, Department of Neuropaediatrics (T. Schmitt-Mechelke, F. Bauder); Lugano: Regional Hospital Lugano, Department of Paediatrics (V. Pezzoli); Muensterlingen: Cantonal Hospital Muensterlingen, Department of Paediatrics (B. Erkert, A. Mueller); Neuchatel: Cantonal Hospital Neuchatel, Department of Paediatrics (M. Ecoffey); St. Gallen: Children’s Hospital St. Gallen, Department of Child Development (A. Lang-Dullenkopf); Winterthur: Cantonal Hospital Winterthur, Social Paediatrics Center (M. von Rhein); Zurich: University Hospital Zurich (USZ), University Children’s Hospital Zurich, Child Development Center (B. Latal, G. Natalucci).
Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Ethics approval and consent to participate: Data collection, evaluation and publication for this study were approved by the Swiss Ethical Committee and the Swiss Federal Commission for Privacy Protection in Medical Research. The study is registered under ClinicalTrials.gov NCT02800018.

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Received: 2019-10-23

Accepted: 2020-01-22

Published Online: 2020-02-18

Published in Print: 2020-03-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2019-0391

Keywords for this article

hypoxic-ischemic encephalopathy; neurodevelopmental outcome; prognostication