Background Neonatal encephalopathy secondary to perinatal asphyxia in term infants commonly results in multi-organ dysfunction (MOD). However methods to accurately and objectively quantify the degree of MOD in NE are lacking.
Objective To develop a scoring system which accurately reflects the degree of MOD in NE and to assess the ability of this score to predict outcome.
Methods Eighty-five term infants with NE were recruited. A score was assigned to abnormalities in each organ system (n = 6) with a maximum score of 15. E.g. In the cardiovascular system, Troponin-T > 0.1 ng/ml = 1, HR <80 = 1. The higher the score assigned, the more significant the MOD. Scores were compared with outcomes of grade of encephalopathy/mortality.
Results Eighty infants had data for all the scoring variables and were included. Higher MOD scores were significantly associated with grade II/III NE (p-value <0.001) and with mortality (p < 0.001) although numbers were small (n = 4). ROC analysis showed that the MOD score was highly predictive of grade II/III NE with AUROC curve = 0.94 (p < 0.001) and cut-off value for best prediction of this outcome was 4.5. For prediction of mortality, AUROC curve was 0.96 (p = 0.002) and cut-off value was 10.5.
Conclusion A scoring system that accurately reflects the degree of MOD in NE would be helpful and allow more objective assessment and comparison of these infants. The proposed MOD score needs to be prospectively validated in term newborns with NE. However it appears that our MOD score in NE is highly predictive of grade II/III NE and mortality.