Purpose: To examine early infant neural behavior parameters scored in a neural encephalopathy score and MRI exams as predictors of neurological abnormalities at twelve months of age in term infants with perinatal asphyxia. Methods: The charts of 70 term infants who satisfied the requirements for enrollment in our birth asphyxia study were evaluated. A reader blinded to the one year neurologic outcome recorded early neonatal information on the duration, severity and nature of neonatal encephalopathy according to the following parameters of neurological behavior: tone, consciousness, seizures, cry, feeding, respiratory difficulty, and primitive reflexes. A simple scoring system reflecting the normal or abnormal status of each of these neural behaviors and ranging from 0-7 was established to record the severity of each infants neonatal encephalopathy. Spearman's rho was used to correlate encephalopathy scores tabulated for days 1, 2, 3, 7 and the day of discharge and T21 weighted MRI scores against the neural outcome at one year. The neural outcome at 1 year was represented by a neuromotor score rating neurologic abnormality according to six different levels. Results: The association between MRI scores and encephalopathy scores was significant (p<0.01) suggesting that hypoxic-ischemic changes manifesting on the MRI correlate with neural behavior in the first week of life. One year outcome was predicted strongly by the early MRI exam(p<0.001) and less so by encephalopathy scores on day 7 and the day of discharge (p<0.012). A simple abnormal/normal encephalopathy score was equally effective at predicting outcome as a more complicated ranked scoring system. Conclusion: Though MRI scores are more strongly correlated with neurologic outcome at one year, early infant neurological behavior recorded in a simple score reflecting the severity of encephalopathy provides useful prognostic information of future neurologic status in high risk term infants.
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Supported by SPR summer traineeship and NIH NS35902
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Meeks, L., Clark, H., Barkovich, A. et al. The Value of Neonatal MRI and Encephalopathy Scores in Predicting One-year Neurological Outcome after Term Asphyxia † 1294. Pediatr Res 43 (Suppl 4), 221 (1998). https://doi.org/10.1203/00006450-199804001-01315
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DOI: https://doi.org/10.1203/00006450-199804001-01315