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Clinical predictors of outcome following mild and moderate neonatal encephalopathy in term newborns in Kathmandu, Nepal
Author(s) -
Ellis M,
Shrestha L,
Shrestha PS,
Manandhar DS,
Bolam AJ,
Costello AM
Publication year - 2001
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2001.tb00311.x
Subject(s) - medicine , pediatrics , cohort , neonatal encephalopathy , encephalopathy , cohort study , prospective cohort study , abnormality , surgery , psychiatry
We describe a clinical grading system for the assessment of neonatal encephalopathy developed for a large prospective study in Kathmandu. Inter‐observer variability testing of our system on 27 infants showed high agreement (kappa value 0.87). Validity for the prediction of major neuro‐developmental impairment at 1 y of age was tested using a cohort of 57 survivors of encephalopathy, all of whom were assessed using a combination of the Denver Developmental Screening Test and Bailey 2 at 1 y. We compared this with a modification of a scoring system previously validated in Cape Town. Both schemes converted a pretest probability of 31% (the prevalence of major impairment at 1 y of age in this cohort) to a post‐test probability of 55%. This showed only marginal improvement over the traditional risk marker of neurological abnormality at discharge (post‐test probability 51%). At 6 wk of age acquired microcephaly increased the probability of major impairment to 79%. Conclusions: It seems to make little difference both in practical or predictive terms whether one describes the neurological condition of the neonate using a descriptive or scoring system. The important thing is to perform repeated systematic neurological examinations on a daily basis during the neonatal period. Many clinicians will justifiably continue to use the discharge examination as the deciding factor for the need for continued neurodevelopmental surveillance.