van der Donk Adriana, Schleier Maria, Bär Alisa, Mulzer Linda, Trollmann Regina, Schuessler Stephanie, Hébert Steven, Hanslik Gregor, Woelfle Joachim, Reutter Heiko, Morhart Patrick
Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.
Department of Pediatrics, Pediatric Neurology, University Hospital Erlangen, Erlangen, Germany.
Front Pediatr. 2025 Aug 6;13:1627300. doi: 10.3389/fped.2025.1627300. eCollection 2025.
Early outcome prediction in neonates with perinatal asphyxia receiving therapeutic hypothermia (TH) remains difficult. Although several studies have explored prognostic markers and proposed scoring systems, none of these tools has been adopted for routine bedside use to date. The present retrospective study aimed to design an early prognostic outcome score (EPO-Score). The score serves to identify patients at discharge, predicting severe adverse outcomes according to the Griffiths Mental Development Scales (GMDS) with one year.
Perinatal data was collected from 44 infants with perinatal asphyxia who had received therapeutic hypothermia between 2010 and 2020 at the University Hospital Erlangen, Germany. 27 predictive variables were analyzed regarding their prognostic significance. Analysis showed significant correlations between 15 variables and their outcome. Outcome at one year was classified as favorable (GMDS DQ > 78) or severe adverse (DQ < 78, cerebral palsy, or death). We combined related variables into four indices: systemic injury, neurologic, liver and renal damage. A forward-looking step-by-step analysis revealed a model, explaining 62.1% of the variance in the outcome (R = 0.621; < 0.001). Based on these results, we developed the EPO-Score and correlated the score to the follow-up assessment at one year.
A total of 32 (out of 44) infants met the inclusion criteria. 25 infants experienced a favorable outcome, 7 infants a severe adverse outcome. The EPO-Score integrates eight routine predictors. Average EPO-Score among all infants was 11 points (range 0-24). The EPO-Score showed significant association with the developmental outcome at one year of age (R = 0.421, < 0.001). ROC-analysis demonstrated the EPO-Score's ability to distinguish between favorable and severe adverse developmental outcome, with a cut-off value of 13.5 (AUC = 0.926; 95% CI 0.831-1.00). Infants with a score of 14 or higher were classified as high-risk.
EPO-Score underlines the correlation between the severity of early multi-organ involvement and severe adverse outcome, demonstrating a high predictive value within our study population. Early identification of patients with severe adverse outcome is important for optimizing neurodevelopmental therapies and providing family support. Nevertheless, external validation is required before the score can be implemented in routine clinical care.
对接受治疗性低温（TH）的围产期窒息新生儿进行早期预后预测仍然具有挑战性。尽管多项研究探索了预后标志物并提出了评分系统，但迄今为止，这些工具均未被用于常规床边使用。本回顾性研究旨在设计一种早期预后结局评分（EPO评分）。该评分用于在出院时识别患者，根据格里菲斯心理发育量表（GMDS）预测其1年内的严重不良结局。
收集了2010年至2020年期间在德国埃尔朗根大学医院接受治疗性低温的44例围产期窒息婴儿的围产期数据。分析了27个预测变量的预后意义。分析显示15个变量与其结局之间存在显著相关性。1年时的结局分为良好（GMDS发育商>78）或严重不良（发育商<78、脑瘫或死亡）。我们将相关变量合并为四个指数：全身损伤、神经、肝脏和肾脏损伤。前瞻性逐步分析得出一个模型，该模型解释了结局中62.1%的方差（R=0.621；P<0.001）。基于这些结果，我们开发了EPO评分，并将该评分与1年时的随访评估进行关联。
共有32例（44例中的）婴儿符合纳入标准。25例婴儿结局良好，7例婴儿结局严重不良。EPO评分整合了8个常规预测指标。所有婴儿的平均EPO评分为11分（范围0 - 24）。EPO评分与1岁时的发育结局显著相关（R=0.421，P<0.001）。ROC分析显示EPO评分能够区分良好和严重不良发育结局，临界值为13.5（AUC=0.926；95%CI 0.831 - 1.00）。评分14分及以上的婴儿被归类为高危。
EPO评分强调了早期多器官受累严重程度与严重不良结局之间的相关性，在我们的研究人群中显示出较高的预测价值。早期识别严重不良结局患者对于优化神经发育治疗和提供家庭支持很重要。然而，在该评分可应用于常规临床护理之前，需要进行外部验证。
