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.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.