Journal
ECLINICALMEDICINE
Volume 36, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.eclinm.2021.100885
Keywords
Therapeutic hypothermia; Moderate or severe perinatal asphyxia; Hypoxic-ischaemic encephalopathy; Neonatal seizures; Neurodevelopmental outcome; Bayley-III; Cerebral palsy; MRI; T1 and T2; White matter; Basal ganglia and thalamus; Posterior limb of the internal capsule; Cortex; Outcome prediction; Logistic regression
Categories
Funding
- UK children's charity SPARKS
- Moulton foundation
- Laerdal Foundation for Acute Medicine
- National Health Service
- University of Bristol
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Binary logistic regression using WMxBGT or TIS along with clinical variables provides excellent outcome prediction for infants with hypoxic-ischaemic encephalopathy, outperforming single variable cross-tabulation methods.
Background: Binary prediction-models for outcome [death, cognition, presence and severity of cerebral palsy (CP)], using MRI and early clinical data applicable for individual outcome prediction have not been developed. Methods: From Dec 1(s)(t) 2006 until Dec 31(st) 2013, we recruited 178 infants into a population-based cohort with moderate or severe hypoxic-ischaemic encephalopathy (HIE) including postnatal collapse (PNC, n = 12) and additional diagnoses (n = 12) using CoolCap/TOBY-trial entry-criteria including depressed amplitude-integrated EEG (aEEG). Early clinical/biochemical variables and MRI scans (median day 8) were obtained in 168 infants. Injury severity was scored for cortex, basal ganglia/thalami (BGT), white matter (WM) and posterior limb of the internal capsule, summating to a total injury score (TIS, range 0-11). Outcome was categorized as adverse or favourable at 18-24 months from Bayley-III domains (cut-off 85) and neurological examination including CP classification. Findings: HIE and entry-aEEG severity were stable throughout the study. Outcome was favourable in 133/178 infants and adverse in 45/178: 17 died, 28 had low Cognition/Language scores, (including 9 with severe CP and 6 mild); seven had mild CP with favourable cognitive outcome. WMxBGT product scores and TIS were strong outcome predictors, and prediction improved when clinical/biochemical variables were added in binary logistic regression. The Positive Predictive Value for adverse outcome was 88%, increasing to 95% after excluding infants with PNC and additional diagnoses. Using WMxBGT in the regression predicted 8 of the 9 children with severe CP. Interpretation: Binary logistic regression with WMxBGT or TIS and clinical variables gave excellent outcome prediction being 12% better than single variable cross-tabulation. Our MRI scoring and regression models are readily accessible and deserve investigation in other cohorts for group and individual prediction. (C) 2021 The Authors. Published by Elsevier Ltd.
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