Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2012 Apr;160(4):567-572.e3.
doi: 10.1016/j.jpeds.2011.09.018. Epub 2011 Nov 1.

Evolution of encephalopathy during whole body hypothermia for neonatal hypoxic-ischemic encephalopathy

Seetha Shankaran  1 , Abbot R Laptook, Jon E Tyson, Richard A Ehrenkranz, Carla M Bann, Abhik Das, Rosemary D Higgins, Rebecca Bara, Athina Pappas, Scott A McDonald, Ronald N Goldberg, Michele C Walsh; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations
Randomized Controlled Trial

Evolution of encephalopathy during whole body hypothermia for neonatal hypoxic-ischemic encephalopathy

Seetha Shankaran et al. J Pediatr. 2012 Apr.

Abstract

Objective: To examine the predictive ability of stage of hypoxic-ischemic encephalopathy (HIE) for death or moderate/severe disability at 18 months among neonates undergoing hypothermia.

Study design: Stage of encephalopathy was evaluated at <6 hours of age, during study intervention, and at discharge among 204 participants in the National Institute of Child Health and Human Development Neonatal Research Network Trial of whole body hypothermia for HIE. HIE was examined as a predictor of outcome by regression models.

Results: Moderate and severe HIE occurred at <6 hours of age among 68% and 32% of 101 hypothermia group infants and 60% and 40% of 103 control group infants, respectively. At 24 and 48 hours of study intervention, infants in the hypothermia group had less severe HIE than infants in the control group. Persistence of severe HIE at 72 hours increased the risk of death or disability after controlling for treatment group. The discharge exam improved the predictive value of stage of HIE at <6 hours for death/disability.

Conclusions: On serial neurologic examinations, improvement in stage of HIE was associated with cooling. Persistence of severe HIE at 72 hours and an abnormal neurologic exam at discharge were associated with a greater risk of death or disability.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure I
Figure I. Classification of Infants According to HIE Grade
Note: The six categories are level of consciousness, spontaneous activity, posture, tone, primitive reflexes, and autonomic system.
Figure II
Figure II
The stage of encephalopathy at <6 hours, 24, 48, 72 and discharge
See this image and copyright information in PMC

References

    1. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. Arch Neurol. 1976;33:696–75. - PubMed
    1. Badawi N, Felix JF, Kurubczuk JJ, Dixon G, Watson L, Keogh JM, et al. Cerebral palsy following term newborn encephalopathy: a population-based study. Dev Med Child Neurol. 2005;47:293–98. - PubMed
    1. Ambalavanan N, Carlo WA, Shankaran S, Bann CM, Emrich SL, Higgins RD, et al. Predicting outcomes of neonates diagnosed with hypoxemic-ischemic encephalopathy. Pediatrics. 2006;118:2084–93. - PubMed
    1. Robertson CM. Long-term follow-up of term infants with perinatal asphyxia. In: Stevenson DK, Benitz WE, Sunshine P, editors. Fetal and Neonatal Brain Injury. Cambridge University Press; 2003. pp. 829–58.
    1. Thompson CM, Puterman AS, Linley LL, Hann FM, van der Elst CW, Molteno CD, et al. The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome. Acta Paediatr. 1997;86:757–61. - PubMed

Publication types

MeSH terms