KEY clinical factors predicting death or severe neurodevelopmental impairment (NDI) in neonates with hypoxic-ischaemic encephalopathy (HIE) treated with hypothermia include severely abnormal EEG, pH ≤7.11, and a 5-minute Apgar score of 0 within 24 hours of birth, as well as specific MRI and EEG findings post-cooling.
This prognostic study aimed to identify reliable predictors of death or severe NDI in neonates with moderate or severe HIE who underwent therapeutic hypothermia. The study included 424 infants born at ≥36 weeks gestation between 2017 and 2019, with follow-up data collected at 2 years. Key clinical, EEG, and MRI variables were assessed during the first 24 hours and post-cooling, and the models were validated using a UK cohort. Outcomes of interest included death or severe NDI, defined by a cognitive score below 70, significant motor impairments, or quadriparesis.
The study found that the presence of severely abnormal EEG, pH ≤7.11, and a 5-minute Apgar score of 0 within 24 hours achieved a specificity of 99.6% and a positive predictive value (PPV) of 95.2%. Post-cooling MRI findings of abnormalities in two or more deep grey matter regions (thalamus, caudate, putamen/globus pallidus) combined with severely abnormal EEG had a specificity of 99.1% and a PPV of 91.7%. Internal and external validation confirmed the robustness of these predictors. Overall, 13.9% of infants died, and 10.8% experienced severe NDI by age 2.
These findings highlight the potential of simple clinical, EEG, and MRI metrics to guide prognosis and early management in neonatal HIE. By identifying neonates at high risk for adverse outcomes, clinicians can focus on tailored interventions, counselling families more effectively about long-term outcomes. Future studies should explore integrating these predictive models into routine clinical workflows and evaluating their impact on decision-making. Further investigation is also warranted to optimise therapeutic strategies for high-risk neonates.
Katrina Thornber, EMJ
Reference
Glass HC et al. Predictors of death or severe impairment in neonates with hypoxic-ischemic encephalopathy. JAMA Netw Open. 2024;7(12):e2449188.
