Early predictors of adverse outcome in term infants with post-asphyxial hypoxic ischaemic encephalopathy

A retrospective study of 35 term infants with post-asphyxial hypoxic-ischaemic encephalopathy (HIE) was conducted to identify early clinical predictors of either death or major motor disability at 18 mo of age. Twenty-three had severe adverse outcome:13 died and 10 had major neurological sequelae. The significant risk factors were a low 5 min Apgar score, use of adrenaline, low first arterial pH and high base deficit. A base deficit greater than or equal to 20 mEq/L is a useful predictor of death or disability with a high positive predictive value (PPV) of 93.8%, followed by 93.3% and 84.2% for pH < 7.1 and 5 min Apgar score <4, respectively. The PPV of death or disability is enhanced in the model combining base deficit of greater than or equal to 20 mEq/L and 5 min Apgar score of <4. This model has a sensitivity of 66.7% and specificity of 100%. Severe metabolic acidosis of base deficit greater than or equal to 25 mEq/L was associated with a high risk of dying: PPV 77.8% and specificity 88.9%.