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Elevated temperature and 6‐ to 7‐year outcome of neonatal encephalopathy
Author(s) -
Laptook Abbot R.,
McDonald Scott A.,
Shankaran Seetha,
Stephens Bonnie E.,
Vohr Betty R.,
Guillet Ronnie,
Higgins Rosemary D.,
Das Abhik
Publication year - 2013
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.23843
Subject(s) - quartile , medicine , confidence interval , odds ratio , gross motor function classification system , cerebral palsy , pediatrics , intelligence quotient , hypothermia , intensive care , physical therapy , cognition , psychiatry , intensive care medicine
Objective A study was undertaken to determine whether higher temperature after hypoxia–ischemia is associated with death or intelligence quotient (IQ)<70 at 6 to 7 years among infants treated with intensive care without hypothermia. Methods Control infants (noncooled, n=106) of the National Institute of Child Health and Human Development Neonatal Research Network hypothermia trial had serial esophageal and skin temperatures over 72 hours. Each infant's temperature was ranked to derive an average of the upper and lower quartile, and median of each site. Temperatures were used in logistic regressions to determine adjusted associations with death or IQ<70 at 6 to 7 years. Secondary outcomes were death, IQ<70, and moderate/severe cerebral palsy (CP). IQ and motor function were assessed with Wechsler Scales for Children and Gross Motor Function Classification System. Results are odds ratio (OR; per degree Celsius increment within the quartile or median) and 95% confidence interval (CI). Results Primary outcome was available for 89 infants. At 6 to 7 years, death or IQ<70 occurred in 54 infants (37 deaths, 17 survivors with IQ<70) and moderate/severe CP in 15 infants. Death or IQ<70 was associated with the upper quartile average of esophageal (OR=7.3, 95% CI=2.0–26.3) and skin temperature (OR=3.5, 95% CI=1.2–10.4). CP was associated with the upper quartile average of esophageal (OR=12.5, 95% CI=1.02–155) and skin temperature (OR=10.3, 95% CI=1.3–80.2). Interpretation Among noncooled infants of a randomized trial, elevated temperatures during the first postnatal days are associated with increased odds of a worse outcome at 6 to 7 years. Ann Neurol 2013;73:520–528