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Incidence and prediction of outcome in hypoxic–ischemic encephalopathy in J apan
Author(s) -
Hayakawa Masahiro,
Ito Yushi,
Saito Shigeru,
Mitsuda Nobuaki,
Hosono Sigeharu,
Yoda Hitoshi,
Cho Kazutoshi,
Otsuki Katsufumi,
Ibara Satoshi,
Terui Katsuo,
Masumoto Kouji,
Murakoshi Takeshi,
Nakai Akihito,
Tanaka Mamoru,
Nakamura Tomohiko
Publication year - 2014
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.12233
Subject(s) - medicine , incidence (geometry) , odds ratio , apgar score , hypoxic ischemic encephalopathy , confidence interval , encephalopathy , pediatrics , pregnancy , fetus , physics , biology , optics , genetics
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.