Abstract
Objective: Assess whether Sarnat staging could predict neurodevelopmental outcome at 24 months of age.
Background: Sarnat staging as neurodevelopmental predictor during therapeutic hypothermia treatment for hypoxic ischemic encephalopathy are currently minimal.
Design/Methods: Retrospective chart review of full-term infants admitted to Morristown Medical Center’s Neonatal Intensive Care Unit from January 2014 – December 2017 that underwent therapeutic hypothermia for suspected HIE. Infants were retrospectively assigned Sarnat scores and classified as mild, moderate, or severe encephalopathy during treatment, post-treatment, and discharge. Developmental data was retrospectively collected at 24mo using Gesell Developmental Assessment Tool.
The raw Gesell score was expressed as a developmental quotient (tested age/actual age). The effect of Sarnat stage on DQ was assessed by multiple regression analysis with DQ as the dependent variable, and gestational age, birth weight, gender, 1- and 5-minute Apgar scores as independent variables.
Results: 23 full-term infants were collected. Developmental data at 24mo and Sarnat scores were available for 14 infants. Mean (SD) birth weight was 3.3 kg (0.47), gestational age 39.0w (0.6), and Apgars 2 (0.75 – 3, median, IQR), 3.5 (1.5 – 5), and 5 (4 – 5) at 1, 5, and 10 minutes. All infants required positive pressure ventilation and 6/14 (43%) required chest compressions at delivery.
The DQ at 24mo significantly correlated with severity of Sarnat score pre-cooling (p = 0.024), as well as days 1 (p=0.038), 2 (p=0.023), and 3 (p=0.023) during cooling; however, not on days 1 (p=0.097), 2 (p=0.11), or 4 (p = 0.061) post-cooling. The Gesell subscales least correlating with Sarnat scores were expressive language and social skills, which were only significant at pre-cooling (p=0.018 and p=0.021).
Conclusions: Sarnat staging continues to be a powerful predictor of long-term neurodevelopment before and during therapeutic hypothermia treatment. This finding may be important in low-resource settings where other potential predictors of long-term outcome may be unavailable.
Disclosure: Dr. Gordon has nothing to disclose. Dr. Griffin has nothing to disclose. Dr. Bennett has nothing to disclose.
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