103 Combining Nucleated Red Blood Cells and Eeg to Predict Sarnat Stage, and Outcome at 2 Years in Neonatal Hie

Abstract

Background and aims: No early biomarker is conclusive in the prediction of outcome in Hypoxic-Ischaemic Encephalopathy (HIE). Both Nucleated Red Blood Cell (NRBC) count and electroencephalogram (EEG) have been shown to predict outcome in isolation. We wished to examine whether combining these markers could improve their predictive ability.

Methods: Term infants were recruited if they had ≥2 of; initial pH < 7.1, 5 minute Apgar score ≤5, and abnormal neurology. Sarnat Score was assigned at 24 hours. NRBC count and continuous multi-channel EEG were recorded within the first 24 hours. Outcome was determined at 2 years using the Revised Griffiths Scales of Mental Development.

Results: Of 44 recruited infants 39 have completed 2 year follow-up. The median NRBC count differed significantly between infants with mild and moderate/severe HIE (8 [0.9-23] versus 16.0 [0.0-239.8], p=0.016), and between infants with normal and abnormal outcome (8.3 [0.0-50] versus 21.3 [1-239.8], p=0.004). The predictive ability of EEG changed with time post-delivery. The combined marker was more robust than EEG in isolation at 12 and 24 hours post-delivery to predict the grade of HIE (12hrs: AUC: 0.80 p=0.003 vs 0.75, p=0.010), (24hrs: AUC 0.81, p=0.001 vs 0.76, p=0.004). At 12 and 24 hours, use of the combined marker also improved prediction of abnormal outcome at 2 years (12hrs: AUC 0.90, p< 0.001 vs 0.80, p=0.004), (24hrs: AUC 0.91, p< 0.001 vs 0.82, p=0.001).

Conclusion: At 12 and 24 hours, using a combination of EEG and NRBC count improved prediction of HIE severity and neurological outcome.

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