Department of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan.
Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
Pediatr Res. 2023 Mar;93(4):1057-1063. doi: 10.1038/s41390-022-02212-7. Epub 2022 Jul 30.
To explore the predictive value of the Thompson score during the first 4 days of life for estimating short-term adverse outcomes in neonatal encephalopathy.
This observational study evaluated infants with neonatal encephalopathy (≥36 weeks of gestation) registered in a multicenter cohort of cooled infants in Japan. The Thompson score was evaluated at 0-24, 24-48, 48-72, and 72-90 h of age. Adverse outcomes included death, survival with respiratory impairment (requiring tracheostomy), or survival with feeding impairment (requiring gavage feeding) at discharge.
Of the 632 infants, 21 (3.3%) died, 59 (9.3%) survived with respiratory impairment, and 113 (17.9%) survived with feeding impairment. The Thompson score throughout the first 4 days accurately predicted death, respiratory impairment, or feeding impairment. The 72-90 h score showed the highest accuracy. A cutoff of ≥15 had a sensitivity of 0.85 and specificity of 0.92 for death or respiratory impairment, while a cutoff of ≥14 had a sensitivity of 0.71 and a specificity of 0.92 for death, respiratory or feeding impairment.
A high Thompson score during the first 4 days of life, especially at 72-90 h could thus be useful for estimating the need for prolonged life support.
The Thompson score on days 1-4 of age was useful in predicting death and respiratory or feeding impairments. The 72-90 h Thompson score showed the highest predictive capability. Owing to the rarity of withdrawal of life-sustaining treatment in Japan, 43% of infants with persistent severe encephalopathy with a Thompson score of ≥15 at 72-90 h of age could regain spontaneous breathing, be extubated, and survive without tracheostomy. Meanwhile, approximately 50% of infants who survived without tracheostomy required gavage feeding. Our results could provide useful information for clinical decision making regarding infants with persistent severe encephalopathy.
探讨生后第 4 天内汤普森评分对预测新生儿脑病短期不良结局的预测价值。
本观察性研究评估了在日本多中心冷却婴儿队列中登记的新生儿脑病（≥36 周妊娠）婴儿。在 0-24、24-48、48-72 和 72-90 小时龄评估汤普森评分。不良结局包括死亡、存活伴呼吸功能障碍（需要气管切开术）或存活伴喂养障碍（需要鼻饲喂养）出院。
632 例婴儿中，21 例（3.3%）死亡，59 例（9.3%）存活伴呼吸功能障碍，113 例（17.9%）存活伴喂养障碍。整个第 1 至 4 天的汤普森评分准确预测了死亡、呼吸功能障碍或喂养障碍。72-90 小时评分具有最高的准确性。截断值≥15 时，死亡或呼吸功能障碍的灵敏度为 0.85，特异性为 0.92，截断值≥14 时，死亡、呼吸或喂养功能障碍的灵敏度为 0.71，特异性为 0.92。
生后第 1 至 4 天的高汤普森评分，尤其是在 72-90 小时，可用于评估是否需要长期生命支持。
1-4 日龄的汤普森评分有助于预测死亡和呼吸或喂养障碍。72-90 小时的汤普森评分具有最高的预测能力。由于在日本很少有放弃维持生命治疗的情况，43%的生后第 72-90 小时汤普森评分≥15 的持续性严重脑病婴儿可恢复自主呼吸，拔管，无需气管切开术存活。同时，约 50%无气管切开术存活的婴儿需要鼻饲喂养。我们的研究结果可为持续性严重脑病婴儿的临床决策提供有用的信息。
