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Background  Hypoxic–ischemic encephalopathy ( HIE ) is one of the most critical pathologic conditions in neonatal medicine due to the potential for neurological deficits in later life. We investigated the incidence of term infants with moderate or severe  HIE  in  J apan and identified prognostic risk factors for poor outcome in  HIE .    Methods  Data on 227 infants diagnosed with moderate or severe  HIE  and born between  J anuary and  D ecember 2008 were collected via nationwide surveys from 263 responding hospitals. Using logistic regression, we examined the relationship between maternal, antepartum, intrapartum, and neonatal risk factors and clinical outcome at 18 months following birth.    Results   I n  J apan, the incidence of moderate or severe  HIE  was 0.37 per 1000 term live births. Outborn births, low  A pgar score at 5 min, use of epinephrine, and low cord blood  pH  were intrapartum factors significantly associated with neurodevelopmental delay and death at 18 months. Serum lactate, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase (all,  P  < 0.001) and creatine kinase ( P  = 0.002) were significantly higher in infants with poor outcome compared to those with favorable outcomes. Abnormal brain magnetic resonance imaging ( MRI) , an important prognostic factor, was significantly associated with poor outcome (odds ratio, 11.57; 95% confidence interval: 5.66–23.64;  P  < 0.001).    Conclusions  Risk factors predicting poor outcome in  HIE  include outborn birth, low Apgar score at 5 min, use of epinephrine, laboratory abnormalities, and abnormal  MRI  findings.

Incidence and prediction of outcome in hypoxic–ischemic encephalopathy in J apan