Original Article

Journal of Perinatology (2005) 25, 245–250. doi:10.1038/sj.jp.7211259 Published online 10 February 2005

Combination of Early Perinatal Factors to Identify Near-Term and Term Neonates for Neuroprotection

Ajay J Talati MD1, Wenjian Yang MS2, Kimberly Yolton PhD3, Sheldon B Korones MD1 and Henrietta S Bada MD4

  1. 1Departments of Pediatrics and Obstetrics and Gynecology (A.J.T., S.B.K.), The University of Tennessee Health Science Center, Memphis, TN, USA
  2. 2Department of Mathematical Sciences (W.Y.), The University of Memphis, Memphis, TN, USA
  3. 3Department of Pediatrics (K.Y.), Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
  4. 4Department of Pediatrics (H.S.B.), The University of Kentucky, Lexington, KY, USA

Correspondence: Ajay J. Talati, MD, 853 Jefferson Ave., Room 201, Memphis, TN 38163, USA

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Abstract

OBJECTIVE:

 

To determine early predictors of abnormal outcome at greater than or equal to24 months' age in neonates at risk for hypoxic–ischemic brain injury.

STUDY DESIGN:

 

A prospective cohort study with developmental follow-up of greater than or equal to24 months. Infants were selected based on risk factors, and neurologic outcome was determined. Variables affecting the outcome were evaluated with univariate and multivariate methods, and a scoring system was devised to predict adverse outcome.

RESULTS:

 

A total of 41 infants born greater than or equal to35 weeks' gestational age with possibility of hypoxic–ischemic insult were enrolled. In all, 39 (95%) had known outcomes, of whom 17 (48%) had an abnormal neurologic outcome, including five deaths. The variables within the first hour of life correlating with the adverse outcome were 1- and 5-minute Apgar scores, intubation in the delivery room and cord/initial base-deficit greater than or equal to20 mmol/l. A scoring system was derived based on significant variables, and a score greater than or equal to5 had a 90% positive predictive value for abnormal outcome. Seizures, multiorgan failure and abnormal imaging studies were also significantly associated with abnormal outcome.

CONCLUSIONS:

 

The proposed scoring system, being highly predictive of outcome at 24 months' age, may be potentially useful in selecting subjects for preventive or therapeutic interventions to prevent or minimize neurologic morbidity due to hypoxic brain injury.

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