Predictive Value of Thompson-Score for Long-Term Neurological and Cognitive Outcome in Term Newborns with Perinatal Asphyxia and Hypoxic-Ischemic Encephalopathy Undergoing Controlled Hypothermia Treatment

摘要

Background: The so-called Thompson-score (TS) for newborns with hypoxic-ischemic encephalopathy (HIE) was developed before the introduction of controlled hypothermia as clinical routine. Information on the predictive value of TS in newborns undergoing therapeutic hypothermia to estimate long-term outcome is limited. Objectives: To determine the predictive value of TS to estimate long-term cognitive and neurological outcome in newborns with perinatal asphyxia treated with controlled hypothermia. Methods: Thirty-six term newborns with HIE undergoing controlled hypothermia were followed using Wechsler Preschool and Primary Scale of intelligence III test and standardized neurological examination. The primary outcome was survival without cognitive impairment, defined as an IQ ≥85. Secondary outcomes were motor outcomes, survival without relevant neurological impairment, death and epilepsy. Results: Follow-up was done in 33 out of 36 (91.6%) infants at 53 ± 12?months (mean ± SD). For all investigated parameters, a statistically significant relationship with peak TS was demonstrated. A one-point increase in peak TS indicated an OR (95% CI) of 1.5 (1.1–2.0, p = 0.006) for death or cognitive impairment, an OR (95% CI) of 2.2 (1.3–3.8, p = 0.004) for death or relevant neurologic impairment, an OR (95% CI) of 2.1 (1.3–3.5, p = 0.005) for death or epilepsy and an OR (95% CI) of 1.5 (1.1–2.1, p = 0.02) for death. Although the TS for newborns with adverse outcome (death or cognitive impairment) compared to normal outcome tended to be higher (13 [4–16] vs. 9 [0–13], d1; 15 [5–19] vs. 9 [1–14], d2; 14 [5–21] vs. 8 [2–15], d3; median [range]), there was a considerable overlap during the first 3 days of life between both groups. Conclusions: The TS seems to be a prognostic tool for predicting the long-term outcome in asphyxiated term newborns undergoing controlled hypothermia after the third day of life. A higher score appears to be significantly associated with an adverse outcome.