Predictors of outcome of neonates with hypoxic ischaemic encephalopathy admitted to the neonatal unit of the University Hospital of the West Indies

Abstract

This was a retrospective review to determine predictors of outcome in term infants with hypoxic ischaemic encephalopathy (HIE) at the University Hospital of the West Indies. Ninety-five neonates fulfilled criteria for entry into the study of these 34 (36%) had a poor outcome. The stage of encephalopathy, seizures on admission, the need for more than one antiepileptic for seizure control and an abnormal neurological examination at hospital discharge were found to be associated with poor outcome. Multiple logistic regression analyses showed that an abnormal neurological examination at discharge was the only independent predictor of poor outcome. Babies who had an abnormal neurological examination at hospital discharge were more likely to have a poor outcome (odds ratio 2.6, confidence interval 0.03-0.4). An abnormal neurological examination at discharge had a positive predictive value of 88% and a negative predictive value of 84% for poor outcome, with a sensitivity and specificity of 60 and 96%, respectively. We recommend that if post-HIE, an infant has an abnormal neurological examination at the time of discharge from hospital, that infant should be followed up and monitored in a specialist neurology clinic and parents counselled about the guarded prognosis for normal neurodevelopmental outcome.