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Am J Perinatol 2018; 35(10): 951-958
DOI: 10.1055/s-0038-1632368
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Illness Severity Predicts Death and Brain Injury in Asphyxiated Newborns Treated with Hypothermia

Hui Wang
1   Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
,
Marc Beltempo
1   Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
,
Emmanouil Rampakakis
2   JSS Medical Research, Montreal, Québec, Canada
,
Priscille-Nice Sanon
1   Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
,
Stephanie Barbosa Vargas
1   Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
,
Julie Maluorni
1   Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
,
Christine Saint-Martin
3   Department of Medical Imaging, Montreal Children's Hospital, McGill University, Montreal, Canada
,
Pia Wintermark
1   Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Canada
› Author Affiliations Funding Pia Wintermark receives research grant funding from the FRSQ Clinical Research Scholar Career Award Junior 2, and the New Investigator Research Grant from the SickKids Foundation and the CIHR Institute of Human Development, Child and Youth Health (IHDCYH).
Further Information

Publication History

06 November 2017

16 January 2018

Publication Date:
16 February 2018 (online)

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Abstract

Objective To determine if illness severity during the first days of life predicts adverse outcome in asphyxiated newborns treated with hypothermia.

Study Design We conducted a retrospective cohort study of asphyxiated newborns treated with hypothermia. Illness severity was calculated daily during the first 4 days of life using the Score for Neonatal Acute Physiology II (SNAP-II score). Adverse outcome (death and/or brain injury) was recorded. Differences in SNAP-II scores between the newborns with and without adverse outcome were assessed.

Result 214 newborns were treated with hypothermia. The average SNAP-II score over the first 4 days of life was significantly worse in newborns developing adverse outcome. The average SNAP-II score was an excellent predictor of death (area under the curve [AUC]: 0.93; p < 0.001) and a fair predictor of adverse outcome (AUC: 0.73; p < 0.001). The average SNAP-II score remained a significant predictor of adverse outcome (odds ratio [95% confidence interval]: 1.08 [1.04–1.12]; p < 0.001), after adjusting for baseline characteristics, degree of initial asphyxial event, and initial severity of encephalopathy.

Conclusion In asphyxiated newborns treated with hypothermia, not only the initial asphyxial event but also the illness severity during the first days of life was a significant predictor of death or brain injury.

Keywords

birth asphyxia - brain - neonatal encephalopathy - newborn - SNAP-II score
 

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