A novel clinical risk scoring system for neurodevelopmental outcomes among survivors of neonatal hypoxic-ischemic encephalopathy (HIE)

IF 2.3 4区 医学 Q2 PEDIATRICS Pediatrics and Neonatology Pub Date : 2024-07-01 DOI:10.1016/j.pedneo.2023.07.006
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Abstract

Objective

We aimed to develop a risk scoring system as a predictor of 24-month neurodevelopmental outcomes (cognitive, language, and motor) for neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE).

Methods

This was a chart review of infants with HIE treated with therapeutic hypothermia who were admitted to the Neonatal Intensive Care Unit (NICU) at the University of Michigan between 2009 and 2019 and followed in the neonatal developmental clinic until 24 months of age. We examined bivariate associations between the neonatal characteristics and Bayley-III scores. We then performed stepwise logistic regression. To create the risk scores, a participant was given one point for each of the factors included in the final model.

Results

Fifty-five infants were included. The final model for Bayley cognitive abnormality included abnormal neonatal neurologic exam (p < 0.0001), white matter/watershed MRI abnormality (p = 0.01), 5-min Apgar score (p = 0.02), and EEG-confirmed seizures (p = 0.04). The model for language abnormality included abnormal neurologic exam (p = 0.0002), seizures (p = 0.007), clinical severity of HIE (p = 0.06), and basal ganglia/thalamus MRI abnormality (p = 0.17). The model for motor abnormality included seizures (p = 0.03), abnormal neurologic exam (p = 0.06) and basal ganglia/thalamus MRI abnormality (p = 0.02). The positive predictive values for the risk scores were 60 %, 85 % and 71 %, respectively, for the Bayley-III cognitive, language and motor domains.

Conclusion

Our study identifies early clinical features that differentially predict domains of neurodevelopmental outcome and associated risk scores that may be of value to both clinicians and families. This novel scoring system should next be validated in a larger, prospective study.

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新生儿缺氧缺血性脑病(HIE)幸存者神经发育结局的新型临床风险评分系统。
目的:我们旨在开发一种风险评分系统,用于预测因缺氧缺血性脑病(HIE)而接受治疗性低温治疗的新生儿24个月神经发育结局(认知、语言和运动)。方法:这是对2009年至2019年期间在密歇根大学新生儿重症监护病房(NICU)接受治疗性低温治疗的HIE婴儿的图表回顾,并在新生儿发育诊所随访至24个月大。我们检查了新生儿特征与贝利- iii评分之间的双变量关联。然后我们进行逐步逻辑回归。为了创建风险评分,参与者会根据最终模型中包含的每个因素得到一分。结果:纳入55名婴儿。Bayley认知异常的最终模型包括异常的新生儿神经系统检查(p)。结论:我们的研究确定了早期临床特征,这些特征可以预测神经发育结局的不同领域和相关的风险评分,这可能对临床医生和家庭都有价值。这种新颖的评分系统下一步应该在更大的前瞻性研究中得到验证。
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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
170
审稿时长
48 days
期刊介绍: Pediatrics and Neonatology is the official peer-reviewed publication of the Taiwan Pediatric Association and The Society of Neonatology ROC, and is indexed in EMBASE and SCOPUS. Articles on clinical and laboratory research in pediatrics and related fields are eligible for consideration.
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