DOI: 10.1097/01.pcc.0000449072.10889.9d
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Issn Print: 1529-7535
Publication Date: 2014/05/01
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Excerpt
Aims: primary aim was to evaluate mortality and severe neurodevelopmental disability, secondary aim to identify risk factors for disability/death on admission.
Methods: Prospective evaluation of critically ill neonates treated for perinatal asphyxia and HIE undergoing HT (target temperature range 33°C-34°C). Neonatal management consisted of optimizing physiological parameters and preventing and/or treating seizures with anticonvulsants: open label phenobarbital (PHE) loading dose 10 - 40 mg/kg and maintenance dose of PHE 2 - 5 mg/kg every 12 h intravenously. Results: are reported as mean (SD), median (interquartile range), and Student’s t test analysis with the 95% confidence interval.
Results: 81/142 neonates (group1:42/81 of neonates with moderate HIE, group2: 39/81 neonates with severe HIE) were included; median time of ICU admission 2.23 (2.2–10.15) hours after insult; body temperature 35.1 (32.0–37.5) °C. Multiorgan dysfunction (MODS) consisted of circulatory failure 77%; renal dysfunction 48%; hepatopathy 62%, and hyperglycaemia 30%. Mortality rate was 11/81 (14%). Morbidity: cerebral palsy 10/81 (12%), epilepsy 5/81 (6%), hearing loss 6/81 (7%), and visual defects 4/81 (5%). Risk factors for disability/death on admission were: severity of HIE (seizures), late normalization of aEEG (over 36 hours), and abnormal neurological examination on discharge. At admission the identified HIE and MODS biochemical parameters - pH, BE, Quick, and lactate were significantly higher (gr2 vs gr1; p<0.0001).
Conclusions: Long term prospective evaluation is essential for optimal evaluation of the effect of therapy on hypoxic-ischemic encephalopathy.
