To identify which early clinical variables are predictive of outcome in newborns with perinatal depression, we prospectively examined newborns with persistently abnormal neurologic examinations at 48 hours and (1) arterial pH = 7.15, (2) 5-minute Apgar = 5, (3) requirement for positive pressure ventilation in the delivery room, or (4) fetal heart rate monitoring abnormalities. Eighty-four such infants completed neurodevelopmental assessment at 1 year. Five-minute Apgar (P = 0.0064), arterial pH (P = 0.0065) and base excess (P = 0.0003), neonatal encephalopathy grade at 48 hours and 7 days (both P = 0.0001), EEG at 48 hours and 7 days (both P = 0.0001), cranial ultrasound (US) at 48 hours (P = 0.0013) and 7 days (P = 0.0002), and the occurrence of neonatal seizures (P = 0.0001) all correlated significantly with developmental outcome, whereas fetal heart rate monitoring, mode of delivery, and presence of the non-neurologic hypoxic-ischemic encephalopathy syndrome did not. In the multivariate analysis, a combination of the 48-hour EEG and 48-hour cranial ultrasound provided the best model to predict developmental outcome, and a point system to predict developmental outcome based on these two variables is proposed.
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http://dx.doi.org/10.1016/s0887-8994(03)00046-8 | DOI Listing |
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