Implementation of newer therapies to prevent/minimize morbidity associated with perinatal asphyxia depends on identification of appropriate outcome predictors. We proposed to identify early clinical markers of perinatal asphyxia predictive of long term outcome. Infants at risk for brain damage from perinatal asphyxia were enrolled if they met 3 of the 5 high risk criteria, (Apgar score(AS) (<4 at 1 min, and or <6 at 5 min), fetal distress as evident by fetal monitoring, cord or admission pH<7.1 and or base deficit(BD)>10, maternal complications in pregnancy/labor and neonatal neurologic status). A point was given per factor within each criteria/cluster. Exclusion criteria were congenital anomalies and gestation age(GA) <29 wk. Data on hospital course and laboratory/imaging results were documented; infants were followed long-term. Abnormal(Abn) outcome was defined as death, gross/ fine motor delay or Abn neurologic exam. To date 39 are enrolled, 35 with known outcome, with 14 Abn (4 deaths) and 21 normal. Mean GA and birthweight were comparable in normal and Abn. infants. Univariate analysis revealed differences (p<.05) in 1-min AS and admission BD. Other factors e.g., admission pH, 5-min AS, lymphocyte count, nRBC, glucose, Ca++, Na+, renal dysfunction, pulmonary hypertension etc. were not significant. Variables significant at p≤.1 were used for logistic procedure. Significant models included variables 1) observed at entry to 1 hr 2) till 24 hr 3) till discharge (table). Infants with multiple risk factors with a BD>20 and seizures would be likely candidates for early therapy. Infants with 1 min AS<3 and Abn imaging study have poor prognosis.

Table 1
Full size table