Accurate prediction of hypoxic-ischaemic encephalopathy at delivery: a cohort study
Accurate prediction of hypoxic-ischaemic encephalopathy at delivery: a cohort study
复制标题
DOI：
10.3109/14767058.2011.653421
复制
发表时间：
2012-09-01
影响因子：
1.8
通讯作者：
Pennell, Craig E.
中科院分区：
文献类型：
--
作者：
White, Christopher R. H.;Doherty, Dorota A.;Pennell, Craig E.
目的：缺氧缺血性脑病（HIE）是围产期窒息的主要急性神经系统表现，与显著的死亡率和发病率相关。本研究旨在建立一种简便、准确的预测新生儿缺氧缺血性脑病的方法。方法：2003年1月至2009年12月期间，所有HIE病例均来自一个三级中心的38，404例分娩。受试者工作曲线（ROC）分析和多变量logistic回归评估临床和生化评估预测HIE的能力。结果：60例新生儿符合HIE诊断标准，其中中重度HIE 39例。单因素分析表明，临床新生儿标志物（Apgar评分和新生儿复苏水平）是比生化标志物（脐动脉pH值，碱过剩和乳酸值）更好的HIE预测。使用2 - 4个预测因子的多变量模型的ROC曲线下面积高达0.98，灵敏度高达93%，特异性高达99%。对于中重度HIE，最有效的预测因素是新生儿复苏水平和动脉乳酸（ROC 0.98，敏感性85%，特异性99%）。结论：脐动脉乳酸和新生儿复苏水平的结合提供了一种快速准确的方法来预测中重度HIE，可以识别出生时可能受益于三级护理和神经保护治疗的新生儿。
Objective: Hypoxic-ischaemic encephalopathy (HIE) is a major acute neurologic manifestation of perinatal asphyxia associated with significant mortality and morbidity. The study aimed to develop a simple, accurate method of predicting HIE at delivery. Methods: Between January 2003 and December 2009, all HIE cases were identified from the 38,404 deliveries at a single tertiary centre. Receiver operating curve (ROC) analysis and multivariate logistic regression assessed the ability of clinical and biochemical assessments to predict HIE. Results: Sixty neonates met the HIE criteria: 39 were moderate-severe HIE. Univariate analyses identified clinical neonatal markers (Apgar scores and neonatal resuscitation level) to be better HIE predictors than biochemical markers (umbilical artery pH, base excess and lactate values). Multivariable models using two to four predictors had areas under ROC curves up to 0.98, sensitivities up to 93% and specificities up to 99%. For moderate-severe HIE, the most effective predictor was neonatal resuscitation level and arterial lactate (ROC 0.98, sensitivity 85%, specificity 99%). Conclusion: The combination of umbilical arterial lactate and neonatal resuscitation level provides a rapid and accurate method of predicting moderate-severe HIE that can identify neonates at birth that may benefit from tertiary care and neuroprotective therapies.