Predictive model of neurodevelopmental outcome in neonatal hypoxic ischemic encephalopathy

Amr I El Shahed; Helen M Branson; Anil Chacko; Sangita Terumalay; Xin Zheng; Elizabeth W Pang; Diane Wilson; Susan Blaser; Vann Chau; Steven P Miller; Hilary E Whyte; Linh G Ly

doi:10.1016/j.earlhumdev.2024.106189

Predictive model of neurodevelopmental outcome in neonatal hypoxic ischemic encephalopathy

Early Hum Dev. 2025 Jan 2:201:106189. doi: 10.1016/j.earlhumdev.2024.106189. Online ahead of print.

Authors

Amr I El Shahed¹, Helen M Branson², Anil Chacko³, Sangita Terumalay⁴, Xin Zheng⁵, Elizabeth W Pang⁶, Diane Wilson⁷, Susan Blaser⁸, Vann Chau⁹, Steven P Miller¹⁰, Hilary E Whyte¹¹, Linh G Ly¹²

Affiliations

¹ Department of Pediatrics, Division of Neonatology, The Hospital for Sick Children and the University of Toronto, Ontario, Canada. Electronic address: [email protected].
² Department of Diagnostic Imaging and Interventional Radiology, The Hospital for Sick Children and the University of Toronto, Ontario, Canada. Electronic address: [email protected].
³ Department of Pediatrics (Division of Neonatology), Surrey Memorial Hospital, British Columbia, Canada. Electronic address: [email protected].
⁴ Pediatric Institute, Hospital Kuala Lampur, Malaysia.
⁵ Department of Pediatrics, Division of Neonatology, The Hospital for Sick Children and the University of Toronto, Ontario, Canada. Electronic address: [email protected].
⁶ Department of Pediatrics, Division of Neurology, The Hospital for Sick Children and the University of Toronto, Ontario, Canada; Neurosciences and Mental Health Research Institute, Toronto, Ontario, Canada. Electronic address: [email protected].
⁷ Department of Pediatrics, Division of Neonatology, The Hospital for Sick Children and the University of Toronto, Ontario, Canada. Electronic address: [email protected].
⁸ Department of Diagnostic Imaging and Interventional Radiology, The Hospital for Sick Children and the University of Toronto, Ontario, Canada. Electronic address: [email protected].
⁹ Department of Pediatrics, Division of Neurology, The Hospital for Sick Children and the University of Toronto, Ontario, Canada; Neurosciences and Mental Health Research Institute, Toronto, Ontario, Canada. Electronic address: [email protected].
¹⁰ Department of Pediatrics, Division of Neonatology, The Hospital for Sick Children and the University of Toronto, Ontario, Canada; Neurosciences and Mental Health Research Institute, Toronto, Ontario, Canada. Electronic address: [email protected].
¹¹ Department of Pediatrics, Division of Neonatology, The Hospital for Sick Children and the University of Toronto, Ontario, Canada. Electronic address: [email protected].
¹² Department of Pediatrics, Division of Neonatology, The Hospital for Sick Children and the University of Toronto, Ontario, Canada. Electronic address: [email protected].

PMID: 39787883
DOI: 10.1016/j.earlhumdev.2024.106189

Abstract

Objectives: To build an early, prognostic model for adverse outcome in infants with hypoxic ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) based on brain magnetic resonance images (MRI), electrophysiological tests and clinical assessments were performed during the first 5 days of life.

Methods: Retrospective study of 182 neonates with HIE and managed with TH. The predominant pattern of HIE brain injury on MRI performed following cooling was scored by neuroradiologists. The electroencephalogram (EEG) background and evoked potential (EP) response, were analyzed. Area under the curve (AUC) of these tools for adverse outcome including death and/or moderate disabilities using the Bayley-III at 36 months were calculated. A stepwise model approach was used to reach the final most efficient predictive model.

Results: Of 182 neonates, 99 were male (54.4 %), with median gestational age of 39 weeks (IQR 38-40) and median weight of 3.3 kg (IQR 2.9-3.7). On admission, 47 (26 %), 104 (57 %) and 31(17 %) neonates presented with mild, moderate and severe encephalopathy respectively. In multivariate analysis of 129 infants who received all prognostic modalities, the predictive value of a model of EEG plus MRI, AUC = 84 %) is equivalent to models of EEG plus MRI with added EP and clinical assessment at discharge (AUC = 84 and 85 % respectively).

Conclusion: In the era of cooling for neonatal HIE, the combination of EEG background and MRI during the first few days of life, provide an objective and highly reliable model for prediction of death and long-term disabilities.

Keywords: Perinatal asphyxia; brain injury; neonatal hypoxic ischemic encephalopathy; neurodevelopmental outcome; therapeutic hypothermia.