Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland.
Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.
J Perinat Med. 2020 Mar 26;48(3):296-303. doi: 10.1515/jpm-2019-0391.
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.
目的 评估接受治疗性低温（TH）的新生儿缺氧缺血性脑病（HIE）在出生后第 4 天内短期神经改善与 18-24 个月神经发育结局的关系。
方法 这是对 2011 年至 2013 年期间在瑞士国家窒息和冷却登记处登记的 174 例 HIE 新生儿前瞻性收集数据的回顾性分析。根据国家指南启动 TH，每日进行 Sarnat 分期。如果 Sarnat 分期从入院到第 4 天生命期改善，则定义为短期神经改善。在 18-24 个月进行标准化神经发育评估。不良结局定义为 2 岁前死亡或随访时严重或中度残疾。
结果 174 例新生儿中有 164 例（94%）接受了 TH，其中 30 例（18%）在新生儿期死亡（无晚期死亡率）。134 例幸存者中有 81%（109 例）在 18-24 个月时接受了随访。在 164 例冷却的新生儿中，62%有短期神经改善，33%的 Sarnat 评分保持不变。短期神经改善与不良结局的比值比（OR）为 0.118（95%置信区间 [CI] 0.051-0.271）。
结论 在 TH 时代，短期神经改善预测 18-24 个月的神经发育结局。临床检查必须成为 HIE 预后综合评估的一部分。
