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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Predictive Models of Neurodevelopmental Outcomes After Neonatal Hypoxic-Ischemic Encephalopathy
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Predictive Models of Neurodevelopmental Outcomes After Neonatal Hypoxic-Ischemic Encephalopathy

机译：新生儿缺氧缺血性脑病后神经发育成果的预测模型

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OBJECTIVES: To develop predictive models for death or neurodevelopmental impairment (NDI) after neonatal hypoxic-ischemic encephalopathy (HIE) from data readily available at the time of NICU admission ("early") or discharge ("cumulative"). METHODS: In this retrospective cohort analysis, we used data from the Children's Hospitals Neonatal Consortium Database (2010-2016). Infants born at >= 35 weeks' gestation and treated with therapeutic hypothermia for HIE at 11 participating sites were included; infants without Bayley Scales of Infant Development scores documented after 11 months of age were excluded. The primary outcome was death or NDI. Multivariable models were generated with 80% of the cohort; validation was performed in the remaining 20%. RESULTS: The primary outcome occurred in 242 of 486 infants; 180 died and 62 infants surviving to follow-up had NDI. HIE severity, epinephrine administration in the delivery room, and respiratory support and fraction of inspired oxygen of 0.21 at admission were significant in the early model. Severity of EEG findings was combined with HIE severity for the cumulative model, and additional significant variables included the use of steroids for blood pressure management and significant brain injury on MRI. Discovery models revealed areas under the curve of 0.852 for the early model and of 0.861 for the cumulative model, and both models performed well in the validation cohort (goodness-of-fit chi(2): P = .24 and .06, respectively). CONCLUSIONS: Establishing reliable predictive models will enable clinicians to more accurately evaluate HIE severity and may allow for more targeted early therapies for those at highest risk of death or NDI.
机译：目的：根据新生儿缺氧缺血性脑病（HIE）入院（“早期”）或出院（“累积”）时现成的数据，建立新生儿缺氧缺血性脑病（HIE）后死亡或神经发育障碍（NDI）的预测模型。方法：在这项回顾性队列分析中，我们使用了儿童医院新生儿联盟数据库（2010-2016）的数据。包括在妊娠≥35周出生并在11个参与部位接受治疗性低体温治疗的HIE婴儿；11个月后未记录婴儿发育贝利评分的婴儿被排除在外。主要结果是死亡或NDI。用80%的队列生成多变量模型；剩下的20%进行了验证。结果：主要转归发生在486名婴儿中的242名；180例死亡，62例存活随访的婴儿患有NDI。在早期模型中，HIE的严重程度、分娩室的肾上腺素给药、呼吸支持和入院时吸入的氧气分数为0.21是显著的。对于累积模型，EEG结果的严重程度与HIE严重程度相结合，其他重要变量包括使用类固醇进行血压管理和MRI上的严重脑损伤。发现模型显示，早期模型的曲线下面积为0.852，累积模型的曲线下面积为0.861，两个模型在验证队列中表现良好（拟合优度chi（2）：P分别为0.24和0.06）。结论：建立可靠的预测模型将使临床医生能够更准确地评估HIE的严重程度，并可能为那些死亡或NDI风险最高的患者提供更有针对性的早期治疗。

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