Department of Neonatology, Amsterdam UMC Locatie University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands.
Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands.
Arch Dis Child Fetal Neonatal Ed. 2023 Dec 15;109(1):41-45. doi: 10.1136/archdischild-2023-325585.
Perinatal asphyxia may be followed by multiple organ dysfunction (MOD) and is often included in prognostication of the individual patient, but evidence of discriminating accuracy is lacking. The aim of this study was to assess whether MOD in asphyxiated neonates during therapeutic hypothermia (TH) predicts mortality or neurodevelopmental impairment (NDI) at 24 months of age and which peripartum variables are associated with the onset of MOD.
A retrospective analysis of a prospective cohort study of asphyxiated newborns undergoing TH was performed. MOD was defined as dysfunction of the brain (encephalopathy) combined with two or more organ systems. Outcome was routinely assessed by standardised developmental testing at the age of 24 months. The predictive accuracy of MOD on the combined outcome and its components (death and NDI) was expressed as areas under the receiver operating characteristic curves (AUROCs). The associations of peripartum variables and development of MOD were expressed as ORs and their CIs.
189 infants (median gestation 40 (range 36-42 weeks) with moderate to severe hypoxic ischaemic encephalopathy were included. 47% developed MOD. The prediction of the combined 24-month outcome or its components showed AUROCs <0.70. Associated with MOD were pH at birth (OR 0.97, CI 0.95 to 0.99), lactate at birth (OR 1.09, CI 1.04 to 1.15), Base Excess (BE) at birth (OR 0.94, CI 0.90 to 0.99) and epinephrine administration during resuscitation (OR 2.09, CI 1.02 to 4.40).
MOD has a low discriminating accuracy in predicting mortality or NDI at 24 months age and might not be useful for prognostication. Signs of acid-base disturbance and adrenalin use at birth are associated with the development of MOD.
围产期窒息可能会导致多器官功能障碍（MOD），并且经常被纳入个体患者的预后评估中，但缺乏鉴别准确性的证据。本研究旨在评估在接受治疗性低温治疗（TH）的窒息新生儿中，MOD 是否可预测 24 个月时的死亡率或神经发育障碍（NDI），以及哪些围产期变量与 MOD 的发生有关。
对接受 TH 的窒息新生儿的前瞻性队列研究进行了回顾性分析。MOD 的定义为脑功能障碍（脑病）合并两个或多个器官系统功能障碍。通过 24 个月时的标准发育测试对结果进行常规评估。MOD 对复合结局及其组成部分（死亡和 NDI）的预测准确性用接受者操作特征曲线下的面积（AUROCs）表示。围产期变量与 MOD 发生的关系用比值比（OR）及其置信区间（CI）表示。
纳入了 189 名（中位胎龄 40 周（范围 36-42 周），患有中重度缺氧缺血性脑病的婴儿。47%的婴儿发生了 MOD。预测 24 个月时的复合结局或其组成部分的 AUROCs<0.70。与 MOD 相关的有出生时的 pH 值（OR 0.97，95%CI 0.95-0.99）、出生时的乳酸（OR 1.09，95%CI 1.04-1.15）、出生时的碱剩余（BE）（OR 0.94，95%CI 0.90-0.99）和复苏时肾上腺素的使用（OR 2.09，95%CI 1.02-4.40）。
MOD 在预测 24 个月时的死亡率或 NDI 方面的鉴别准确性较低，可能不适用于预后评估。出生时酸碱失衡和肾上腺素使用的迹象与 MOD 的发生有关。
