61 Predicting Death Despite Therapeutic Hypothermia in Infants with Hypoxic Ischemic Encephalopathy (HIE)

Abstract

To avoid offering false hope to parents it is important to identify potentially untreatable cases of HIE for whom cooling may not be of benefit. Objective: To determine pre-cooling attributes that could predict death in infants with HIE despite cooling.Methods: 85 infants of ≥ 36 weeks' gestation who received cooling for HIE were reviewed. Logistic regression analysis was performed using pre-cooling clinical/ laboratory variables with HIE related death during first 9 months of life as primary outcome.Results: Thirteen (15%) of 85 infants with HIE died during 9-18 months follow up despite cooling. In all, 27 of 85 infants were asystolic at birth but only 12 of these infants had Apgar of zero at both 5 and 10 minutes. Univariate analysis identified Apgar of zero at 5 minutes and at 10 minutes, pH < 6.7, base deficit >22 mmol/L, and absent spontaneous movement as being significant but on multivariate analysis, only Apgar score of zero at 10 minutes (p< 0.001, OR 51.7, 95% CI 9.9 - 269.5) remained significantly associated with primary outcome. Of 12 infants who were asystolic at and beyond 10 minutes of life, 9 died from HIE, 2 had spastic quadriparesis at 18-24 months, and one had extensive encephalomalacia on brain MRI.Conclusions: Among all pre-cooling variables, only 10 minute Apgar score is independently associated with death despite cooling. Furthermore, infants who remain asystolic at 10 minutes and beyond are unlikely to survive despite cooling, and the rare survivor is likely to survive with severe disability.