Incidence and prediction of outcome in hypoxic–ischemic encephalopathy in Japan

Abstract

BackgroundHypoxic–ischemic encephalopathy (HIE) is one of the most critical pathologic conditions in neonatal medicine due to the potential for neurological deficits in later life. We investigated the incidence of term infants with moderate or severe HIE in Japan and identified prognostic risk factors for poor outcome in HIE.MethodsData on 227 infants diagnosed with moderate or severe HIE and born between January and December 2008 were collected via nationwide surveys from 263 responding hospitals. Using logistic regression, we examined the relationship between maternal, antepartum, intrapartum, and neonatal risk factors and clinical outcome at 18 months following birth.ResultsIn Japan, the incidence of moderate or severe HIE was 0.37 per 1000 term live births. Outborn births, low Apgar score at 5 min, use of epinephrine, and low cord blood pH were intrapartum factors significantly associated with neurodevelopmental delay and death at 18 months. Serum lactate, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase (all, P < 0.001) and creatine kinase (P = 0.002) were significantly higher in infants with poor outcome compared to those with favorable outcomes. Abnormal brain magnetic resonance imaging (MRI), an important prognostic factor, was significantly associated with poor outcome (odds ratio, 11.57; 95% confidence interval: 5.66–23.64; P < 0.001).ConclusionsRisk factors predicting poor outcome in HIE include outborn birth, low Apgar score at 5 min, use of epinephrine, laboratory abnormalities, and abnormal MRI findings.

Therapeutic hypothermia for neonatal encephalopathy: a report from the first 3 years of the Baby Cooling Registry of Japan

“…We would expect to see 1,000–2,000 cases of neonatal encephalopathy each year given that the incidence of neonatal encephalopathy is approximately 1–2 per 1,000 live births in developed countries21, but just over 500 cases were recorded in the registry over 3 years. Hayakawa and colleagues have, however, estimated that the incidence of moderate to severe neonatal encephalopathy in Japan is 0.37 per 1,000 live births22. Considering that 219 of 287 registered level II-III neonatal intensive care centres participated in the current registry (76.3%), our database is likely to have included the majority of eligible neonates.…”

Human Umbilical Cord Blood CD34-Positive Cells as Predictors of the Incidence and Short-Term Outcome of Neonatal Hypoxic-Ischemic Encephalopathy: A Pilot Study

“…Several clinical, laboratory, electrophysiological, and imaging measures have been used to predict the coincident and subsequent potential brain damage with the aim of developing decisive prognostic criteria 8. Scoring systems to help predict death and disability have been subjected to continual stringent assessment and validation 9. However, this has not been the case for acute-stage parameters predictive of occurrence and short-term outcomes 10…”

Is Erythropoietin Combining with Therapeutic Hypothermia an Efficient and Safe Therapy in Neonatal Hypoxic Ischemic Encephalopathy: A Prospective and Randomized Clinical Trial

“…(9) During our study, no patients developed polycythemia and venous thromboses.Unlike previous study, we focused on several potential neurological outcome related biomarkers which were widely detected in routine clinical work. Evidence revealed high serum level of CK and LDH was contributed to poor outcome in HIE neonates (14,26). Our results showed higher level of CK decreased obviously in both group after treatment, while average level of CK in Epo group was closer to normal value than placebo group.…”

“…CK, usually used in judging myocardial ischemic injury, have also been found that high level was associated with serious brain damage. (14) LDH, one of the important enzyme participating in anaerobic glycolysis and gluconeogenesis, have been demonstrated the level was signi cantly higher in the HIE group. (15) Besides, HI triggers the disruption of ionic homeostasis, characterizing by enhanced K + e ux and Na + , Ca 2+ in ux, which has been considered as the most important alteration which eventually leads to cell death or injury.…”