Predictive value of the Thompson score for short-term adverse outcomes in neonatal encephalopathy
Predictive value of the Thompson score for short-term adverse outcomes in neonatal encephalopathy
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DOI：
10.1038/s41390-022-02212-7
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发表时间：
2022-07-30
影响因子：
3.6
通讯作者：
Iwata, Osuke
中科院分区：
文献类型：
--
作者：
Aoki, Hirosato;Shibasaki, Jun;Iwata, Osuke
目的探讨出生后4天内Thompson评分对估计新生儿脑病短期不良结局的预测价值。方法本观察性研究评估了在日本多中心队列研究中登记的新生儿脑病（>= 36周妊娠）婴儿。在0-24、24-48、48-72和72-90 h龄时评价Thompson评分。不良结局包括出院时死亡、呼吸障碍生存（需要气管造口术）或进食障碍生存（需要灌胃喂养）。结果632例患儿中死亡21例（3.3%），呼吸功能障碍存活59例（9.3%），喂养功能障碍存活113例（17.9%）。汤普森评分在前4天准确预测死亡，呼吸障碍，或喂养障碍。72-90 h评分的准确性最高。临界值>= 15对死亡或呼吸障碍的敏感性为0.85，特异性为0.92，而临界值>= 14对死亡、呼吸或进食障碍的敏感性为0.71，特异性为0.92。结论新生儿出生后4 d内，尤其是72-90 h内的Thompson评分较高，可用于评估是否需要延长生命支持。影响1-4日龄的Thompson评分有助于预测死亡和呼吸或喂养障碍。72-90 h Thompson评分显示最高的预测能力。由于在日本很少停止维持生命的治疗，在72-90 h龄时Thompson评分>= 15的持续性重度脑病婴儿中，43%可以恢复自主呼吸，拔管，无需气管切开术存活。与此同时，大约50%没有气管切开术存活的婴儿需要灌胃喂养。我们的研究结果可以提供有用的信息，为临床决策的婴儿持续严重的脑病。
Background To explore the predictive value of the Thompson score during the first 4 days of life for estimating short-term adverse outcomes in neonatal encephalopathy. Methods This observational study evaluated infants with neonatal encephalopathy (>= 36 weeks of gestation) registered in a multicenter cohort of cooled infants in Japan. The Thompson score was evaluated at 0-24, 24-48, 48-72, and 72-90 h of age. Adverse outcomes included death, survival with respiratory impairment (requiring tracheostomy), or survival with feeding impairment (requiring gavage feeding) at discharge. Results Of the 632 infants, 21 (3.3%) died, 59 (9.3%) survived with respiratory impairment, and 113 (17.9%) survived with feeding impairment. The Thompson score throughout the first 4 days accurately predicted death, respiratory impairment, or feeding impairment. The 72-90 h score showed the highest accuracy. A cutoff of >= 15 had a sensitivity of 0.85 and specificity of 0.92 for death or respiratory impairment, while a cutoff of >= 14 had a sensitivity of 0.71 and a specificity of 0.92 for death, respiratory or feeding impairment. Conclusion A high Thompson score during the first 4 days of life, especially at 72-90 h could thus be useful for estimating the need for prolonged life support. Impact The Thompson score on days 1-4 of age was useful in predicting death and respiratory or feeding impairments. The 72-90 h Thompson score showed the highest predictive capability. Owing to the rarity of withdrawal of life-sustaining treatment in Japan, 43% of infants with persistent severe encephalopathy with a Thompson score of >= 15 at 72-90 h of age could regain spontaneous breathing, be extubated, and survive without tracheostomy. Meanwhile, approximately 50% of infants who survived without tracheostomy required gavage feeding. Our results could provide useful information for clinical decision making regarding infants with persistent severe encephalopathy.