McMaster University, Hamilton, Canada.
JSS Academy of Higher Education and Research, JSS Medical College, Mysuru, Karnataka, India.
J Perinat Med. 2021 Apr 15;49(6):748-754. doi: 10.1515/jpm-2020-0299. Print 2021 Jul 27.
Neonates who develop moderate to severe encephalopathy following perinatal asphyxia will benefit from therapeutic hypothermia. Current National Institute of Child Health and Human Development (NICHD) criteria for identifying encephalopathic neonates needing therapeutic hypothermia has high specificity. This results in correctly identifying neonates who have already developed moderate to severe encephalopathy but miss out many potential beneficiaries who progress to develop moderate to severe encephalopathy later. The need is therefore not just to diagnose encephalopathy, but to predict development of encephalopathy and extend the therapeutic benefit for all eligible neonates. The primary objective of the study was to develop and validate the statistical model for prediction of moderate to severe encephalopathy following perinatal asphyxia and compare with current NICHD criteria.
The study was designed as prospective observational study. It was carried out in a single center Level 3 perinatal unit in India. Neonates>35 weeks of gestation and requiring resuscitation at birth were included. Levels of resuscitation and blood gas lactate were used to determine the pre-test probability, Thompson score between 3 and 5 h of life was used to determine post-test probability of developing encephalopathy. Primary outcome measure: Validation of Prediction of Encephalopathy in Perinatal Asphyxia (PEPA) score by Holdout method.
A total of 55 babies were included in the study. The PEPA score was validated by Holdout method where the fitted receiver-operating characteristic (ROC) area for the training and test sample were comparable (p=0.758). The sensitivity and specificity of various PEPA scores for prediction of encephalopathy ranged between 74 and 100% in contrast to NICHD criteria which was 42%. PEPA score of 30 had a best combination of sensitivity and specificity of 95 and 89% respectively.
PEPA score has a higher sensitivity than NICHD criteria for prediction of Encephalopathy in asphyxiated neonates.
患有围产期窒息后中重度脑病的新生儿将受益于治疗性低温。目前，美国国立儿童健康与人类发展研究所（NICHD）确定需要治疗性低温的脑病新生儿的标准具有很高的特异性。这导致正确识别已经发展为中重度脑病的新生儿，但错过了许多可能后来发展为中重度脑病的潜在受益人群。因此，不仅需要诊断脑病，还需要预测脑病的发展，并为所有符合条件的新生儿延长治疗效益。本研究的主要目的是开发和验证预测围产期窒息后中重度脑病的统计模型，并与当前的 NICHD 标准进行比较。
该研究设计为前瞻性观察研究。它在印度的一家单中心三级围产期病房进行。纳入胎龄>35 周且在出生时需要复苏的新生儿。复苏水平和血乳酸水平用于确定预测试概率，出生后 3-5 小时的 Thompson 评分用于确定发生脑病的后测试概率。主要结局测量：采用 Holdout 法验证围产期窒息性脑病预测（PEPA）评分。
共有 55 名婴儿纳入研究。通过 Holdout 法验证了 PEPA 评分，其中训练和测试样本的拟合接收者操作特征（ROC）面积具有可比性（p=0.758）。与 NICHD 标准的 42%相比，各种 PEPA 评分预测脑病的敏感性和特异性在 74%至 100%之间。PEPA 评分 30 具有最佳的敏感性和特异性组合，分别为 95%和 89%。
PEPA 评分预测窒息新生儿脑病的敏感性高于 NICHD 标准。
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