Three-year outcome following neonatal encephalopathy in a high-survival cohort

Abstract

This study investigated the 3-year clinical outcomes in relation to the severity of encephalopathy in high-survival infants who underwent therapeutic hypothermia. This retrospective observational study was conducted in level II/III neonatal intensive care units in Japan. The nationwide cohort included 474 infants registered in the Baby Cooling Registry of Japan between January 2012 and December 2016. Clinical characteristics, mortality rate and severe neurological impairment at age 3 years were evaluated. Of the infants, 48 (10.4%), 291 (63.1%) and 122 (26.5%) had mild, moderate and severe encephalopathy, respectively, upon admission. By age 3, 53 (11.2%) infants died, whereas 110 (26.1%) developed major disabilities. The mild group survived up to age 3. In the moderate group, 13 (4.5%) died and 44 (15.8%) developed major disabilities. In the severe group, 39 (32.0%) died by age 3. Adverse outcomes were observed in 100 (82.0%) infants. Mortality was relatively low in all subgroups, but the incidence of major disabilities was relatively high in the severe group. The relatively low mortality and high morbidity may be due to Japanese social and ethical norms, which rarely encourage the withdrawal of intensive life support. Cultural and ethical backgrounds may need to be considered when assessing the effect of therapeutic interventions.

Mild hypothermia reduces spreading depolarizations and infarct size in a swine model

“…In similar scenarios, clinical trials have shown that hypothermia improved clinical outcomes in comatose survivors of out-of-hospital cardiac arrest 13 and neonatal hypoxic-ischemic encephalopathy. 13,14 Following the primary injury, patients with ischemic stroke can endure secondary damage and infarct growth from excitotoxicity, blood-brain barrier damage, SDs, and other deleterious processes. These may lead to cerebral edema, mass effects, and worse outcomes despite timely administration of reperfusion therapies.…”

Outcomes in children after mild neonatal hypoxic ischaemic encephalopathy: A population‐based cohort study

“…Few studies have investigated the association between mild HIE, cerebral palsy and epilepsy specifically. Chalak et al 28 reported one case of cerebral palsy (2.3%) 18–22 months after mild HIE in a cohort of 43 infants, whereas Tsuda et al 30 reported two cases (4.2%) at 3 years’ follow‐up in a cohort of 48 infants with mild HIE. In the study by Tsuda et al, one of the infants with cerebral palsy also had epilepsy (2%).…”

Prolonged requirements for mechanical ventilation and tube feeding support predicted 18‐month outcomes for neonatal encephalopathy

“…Third, we were unable to use the information about neurodevelopmental outcomes assessed using standardised batteries. Outcome assessments using individualised batteries were available only for 45% of infants 26 . Instead, we used a surrogate outcome marker, or the incidence of moderate‐to‐severe disabilities in sensory and gross motor function as the primary outcome.…”

“…Outcome assessments using individualised batteries were available only for 45% of infants. 26 Instead, we used a surrogate outcome marker, or the incidence of moderate-to-severe disabilities in sensory and gross motor function as the primary outcome.…”