Illness Severity Predicts Death and Brain Injury in Asphyxiated Newborns Treated with Hypothermia.

OBJECTIVE:  To determine if illness severity during the first days of life predicts adverse outcome in asphyxiated newborns treated with hypothermia.

STUDY DESIGN:  We conducted a retrospective cohort study of asphyxiated newborns treated with hypothermia. Illness severity was calculated daily during the first 4 days of life using the Score for Neonatal Acute Physiology II (SNAP-II score). Adverse outcome (death and/or brain injury) was recorded. Differences in SNAP-II scores between the newborns with and without adverse outcome were assessed.

RESULT:  214 newborns were treated with hypothermia. The average SNAP-II score over the first 4 days of life was significantly worse in newborns developing adverse outcome. The average SNAP-II score was an excellent predictor of death (area under the curve [AUC]: 0.93; p  < 0.001) and a fair predictor of adverse outcome (AUC: 0.73; p  < 0.001). The average SNAP-II score remained a significant predictor of adverse outcome (odds ratio [95% confidence interval]: 1.08 [1.04-1.12]; p  < 0.001), after adjusting for baseline characteristics, degree of initial asphyxial event, and initial severity of encephalopathy.

CONCLUSION:  In asphyxiated newborns treated with hypothermia, not only the initial asphyxial event but also the illness severity during the first days of life was a significant predictor of death or brain injury.