Early predictors of adverse outcome in term infants with post-asphyxial hypoxic ischaemic encephalopathy

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Abstract
Toh VC. Early predictors of adverse outcome in term infants with post‐asphyxial hypoxic ischaemic encephalopathy. Acta Pædiatr 2000; 89: 343‐7. Stockholm. ISSN 0803–5253 Severe metabolic acidosis of base deficit ≥25 mEq/L was associated with a high risk of dying: PPV 77.8% and specificity 88.9%. A retrospective study of 35 term infants with post‐asphyxial hypoxic‐ischaemic encephalopathy (HIE) was conducted to identify early clinical predictors of either death or major motor disability at 18 mo of age. Twenty‐three had severe adverse outcome: 13 died and 10 had major neurological sequelae. The significant risk factors were a low 5 min Apgar score, use of adrenaline, low first arterial pH and high base deficit. A base deficit ≥20 mEq/L is a useful predictor of death or disability with a high positive predictive value (PPV) of 93.8%, followed by 93.3% and 84.2% for pH < 7.1 and 5 min Apgar score <4, respectively. The PPV of death or disability is enhanced in the model combining base deficit of ≥20 mEq/L and 5 min Apgar score of <4. This model has a sensitivity of 66.7% and specificity of 100%.

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