Predictive Factors of Poor Prognosis in Neonates with Hypoxic Ischemic Encephalopathy Receiving Hypothermia

Introduction: The prevalence of perinatal asphyxia is ۰.۵% to ۲%. Severe perinatal asphyxia results in multiple organ involvement, neonate hospitalization and eventualdeath. The present study investigated factors predicting poor prognosis in newborns with hypoxic ischemic encephalopathy (HIE) receiving hypothermia. Methods: This cross-sectional descriptive study was performed retrospectively for ۵ years in the Fatemieh Hospital of Hamadan on ۵۱ newborns who were admitted to the NICU with a diagnosis of HIE, confirmed by a neonatologist, and treated with cool cap. The required data, including mother’s age, newborn’s gender and weight, gestational age, delivery method, seizure, neonatal resuscitation, ۱- and ۵-minute Apgar scores, blood gas analysis, analysis of CPK and LDH enzymes, brain imaging results, electroencephalography (a-EEG), need for ventilator and infant outcome (death or recovery) were extracted from the patients’ medical records files, recorded in a premade questionnaire and analyzed using SPSS ۱۶. Results: The mean gestational age and birth weight were ۳۸.۳±۱.۶ weeks and ۳۱۳۲±۴۷۷g. Seizure, mechanical ventilation, and severely abnormal a-EEG wereobserved in ۲۲, ۳۱, and ۲۰ neonates, respectively. Sixteen infants (۳۱%) died. Comparison of the living and dead infants in terms of effective factors influencing deathof infants with asphyxia receiving cool-cap therapy indicated that there were significant relationships between death and advanced neonatal resuscitation (intra-tracheal intubation and/or chest compression and/or drug administration) (P-Value=۰.۰۰۲), requirement for mechanical ventilation (P-Value=۰.۰۱۶), ۱-minute Apgar score (P-Value=۰.۰۴۰), and severely abnormal EEG (P-Value=۰.۰۴۷). Multiple regression of variables or data showed that advanced neonatal resuscitation was an independent birth-related death factor (P-Value=۰.۰۰۷۵) and severely abnormal EEG was related to asphyxia severity (PValue= ۰.۰۰۰۱). The odds ratios also indicated that the chance of stage ۳ to stage ۲ in neonates with severely abnormal EEG was ۶۳ times higher than neonates with normal a- EEG, and severely abnormal a-EEG was an independent predictor of poor prognosis. Conclusion: This study showed that advanced neonatal resuscitation, need for mechanical ventilation, low ۱-minute Apgar score, and severely abnormal a-EEG were independent predictors of poor prognosis in infants with HIE.

کلیدواژه ها:

Hypoxic Ischemic Encephalopathy (HIE) ، Prognosis ، Patient Outcome Assessment ، Cool-Cap ، Neonate.