OBJECTIVE: To examine early magnetic resonance imaging (MRI), early newborn neurologic exam, blood acid-base status, absence of fetal heart rate (FHR) variability, and Apgar score as predictors of neurologic outcome at 3 months of age.

DESIGN: The study consisted of 25 infants ≥ 36 weeks gestation by obstetric dating or by maturational age (by Ballard exam), who had umbilical artery pH ≤ 7.1, base excess of ≤ -10mEq/l, or Apgar score of < 5 at 5 minutes. FHR tracings were read retrospectively by a blinded observer for the presence or absence of variability throughout the last 5 minutes before delivery. Each infant had a physical exam on the first day of life, and then an MRI scan at a mean age of 6.1 days (range, 1-17) days). At 3 months, a neurological exam was done by a neurologist blind to the infant's prior history.

RESULTS: The following predictive values were calculated based on the ability of each variable to predict neurological outcome status at 3 months as“normal” or “abnormal.”Table

Table 1
Full size table

CONCLUSION: The best predictors of 3 months neurologic exam were the newborn exam and MRI. Poor performance of pH, base excess, absence of FHR variability, and Apgar scores in predicting neurologic status confirms that there are other causes of abnormal neurologic status after perinatal asphyxia as defined by our obstetric and neonatal inclusion criteria. The preliminary data suggest that early MRI scans should be further examined as a potentially valuable predictor of ultimate outcome.