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PS-154 Has Therapeutic Hypothermia (th) Changed The Prognostic Value Of Clinical Evaluation Of Neonatal Hypoxic-ischaemic Encephalopathy (hie)? A Systematic Review And Meta-analysis
  1. A Alarcon Allen1,
  2. C Ochoa2,
  3. R del Rio3,
  4. J Gonzalez de Dios4,
  5. J Arnaez5,
  6. G Arca6,
  7. A Balaguer7,
  8. A Garcia-Alix3,8 Working Group for the National Health System Clinical Practice Guideline on Neonatal Hypoxic-Ischaemic Encephalopathy
  1. 1Neonatal Unit, Oxford University Hospitals NHS Trust, Oxford, UK
  2. 2Service of Paediatrics, Complejo Asistencial de Zamora, Zamora, Spain
  3. 3Neonatal Unit Hospital Sant Joan de Deu, Agrupacio Sanitaria Sant Joan de Deu-Hospital Clinic Universitat de Barcelona, Barcelona, Spain
  4. 4Department of Paediatrics, Hospital General Universitario de Alicante Universidad Miguel Hernandez, Alicante, Spain
  5. 5Neonatal Unit, Hospital Universitario de Burgos, Burgos, Spain
  6. 6Neonatal Unit Hospital Clinic, Agrupacio Sanitaria Sant Joan de Deu-Hospital Clinic Universitat de Barcelona, Barcelona, Spain
  7. 7Department of Paediatrics, Hospital General de Catalunya Universitat Internacional de Catalunya, Barcelona, Spain
  8. 8Spain

Abstract

Background Clinical grading of HIE correlates with outcome. TH improves survival and neurodevelopment in HIE. Aim: To review the effect of TH on the prognostic value of clinical grading of HIE and its course.

Methods Systematic review and meta-analysis of studies on the ability of Sarnat stage at defined times to predict death/disability at ≥18 m in normothermia and TH-treated term neonates with HIE. Pooled risks were estimated, with random effect models, according to HIE stage and treatment.

Results Data on encephalopathy stage at <6 h were available from seven TH trials including 1214 newborns with moderate/severe HIE. Post-hoc studies of two trials (381 infants) provided 72 h data.

The proportion of infants with moderate encephalopathy at <6 h who had poor outcome was 52% (95% CI:44–60; I2 = 48%) in normothermia-treated and 35% (95% CI:28–41; I2 = 51%) in TH-treated neonates. The proportion for severe encephalopathy was 83% (95% CI:72–93; I2 = 81%) in normothermia and 67% (95% CI:58–76; I2 = 74%) in TH. At <6 h, the OR for severe vs moderate HIE to predict unfavourable outcome was 4.14 (95% CI:2.40–7.13; I2 = 35%) in normothermia and 3.77 (95% CI:2.62–5.41; I2 = 0%) in TH.

TH did not affect HIE grade at 72 h. No improvement of encephalopathy at 72 h increased the risk of poor outcome (OR 8.21, 95% CI:2.01–33.6; I2 = 74%). The ORs for persistent moderate and severe encephalopathy at 72 h to predict unfavourable outcome were 5.09 (95% CI:1.53–16.92; I2 = 66%) and 42.83 (95% CI:13.55–135.37; I2 = 44%).

Conclusions While TH has changed the predictive values of initial HIE grades, clinical staging at <6 h correlates with outcome. The course of encephalopathy throughout TH is valuable in outcome prediction.

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