Prediction of one year outcome after perinatal asphyxia † 945

Abstract

Outcome after perinatal asphyxia can vary widely and most neonatal clinical parameters have failed to aid in predicting outcome. Neonatal MRI has been shown to correlate well with subsequent neurologic outcome but its usefulness has not been compared to neonatal variables. We now report data on neurologic outcome at one year in 36 term infants with perinatal asphyxia and evaluate the role of neonatal MRI and neonatal clinical parameters in predicting outcome. Design: Prospective cohort study of term infants with perinatal asphyxia. Methods: Obstetric and clinical neonatal information was assessed via chart review; neonatal seizures were graded according to severity (score 0-11). T2 first echo MRI abnormalities assessed in the first ten days of life were graded from 0 to 4. Neurologic outcome at one year, assessed by a child neurologist blinded to neonatal and radiological findings, was defined as normal or abnormal. Developmental outcome was assessed using Bayley Scales of Infant Development II. Results: Seventeen subjects were abnormal and 19 were normal at one year. First echo T2 MRI was the most significant predictor of abnormal neurologic outcome(p=.0002) and abnormal developmental outcome (p=.01). High seizure scores were also associated with abnormal neurologic (p=.02) and developmental (p=.04) outcome. All other obstetric and neonatal clinical variables (meconium stained amniotic fluid, mode of delivery, pH, BE, Apgar scores, head circumference) were not different between the two outcome groups. Conclusion: Standard MRI examination in the first days of life is the best predictor of neurodevelopmental impairment at one year of life. Severity of neonatal seizures was also predictive of abnormal outcome. Supported by 1P20NS32553 and MO1RRO1271