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April 14, 2020; 94 (15 Supplement) Wednesday, April 29

Sarnat Staging as Clinical Prognostic Tool to Assess Neurodevelopmental Outcome at 24 months of Age in Full Term Infants Treated with Therapuetic Hypothermia for Hypoxic Ischemic Encephalopathy (563)

Danielle Gordon, Ian Griffin, Harvey Bennett
First published April 14, 2020,
Danielle Gordon
1Goryeb Children’s Hospital
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Ian Griffin
2Morristown Medical Center
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Harvey Bennett
2Morristown Medical Center
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Citation
Sarnat Staging as Clinical Prognostic Tool to Assess Neurodevelopmental Outcome at 24 months of Age in Full Term Infants Treated with Therapuetic Hypothermia for Hypoxic Ischemic Encephalopathy (563)
Danielle Gordon, Ian Griffin, Harvey Bennett
Neurology Apr 2020, 94 (15 Supplement) 563;

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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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