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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

Predictive Models of Neurodevelopmental Outcomes After Neonatal Hypoxic-Ischemic Encephalopathy

Eric S. Peeples, Rakesh Rao, Maria L.V. Dizon, Yvette R. Johnson, Priscilla Joe, John Flibotte, Tanzeema Hossain, Danielle Smith, Shannon Hamrick, Robert DiGeronimo, Girija Natarajan, Kyong-Soon Lee, Toby D. Yanowitz, Ulrike Mietzsch, Tai-Wei Wu, Nathalie L. Maitre, Eugenia K. Pallotto, Mark Speziale, Amit M. Mathur, Isabella Zaniletti, An Massaro and on behalf of the Children’s Hospitals Neonatal Consortium Hypoxic-Ischemic Encephalopathy Focus Group
Pediatrics February 2021, 147 (2) e2020022962; DOI: https://doi.org/10.1542/peds.2020-022962
Eric S. Peeples
aDepartment of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska;
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Rakesh Rao
bDepartment of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri;
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Maria L.V. Dizon
cDepartment of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University, Chicago, Illinois;
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Yvette R. Johnson
dDepartment of Pediatrics, Cook Children’s Medical Center, Fort Worth, Texas;
eDepartment of Pediatrics, Texas Christian University and University of North Texas Health Science Center, Fort Worth, Texas;
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Priscilla Joe
fDepartment of Pediatrics, University of California, San Francisco Benioff Children’s Hospital, Oakland, California;
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John Flibotte
gDepartment of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;
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Tanzeema Hossain
hDepartment of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;
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Danielle Smith
iDepartment of Pediatrics, University of Colorado Denver, Denver, Colorado;
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Shannon Hamrick
jDepartment of Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia;
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Robert DiGeronimo
kDepartment of Pediatrics, University of Washington, Seattle, Washington;
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Girija Natarajan
lDepartment of Pediatrics, Children’s Hospital of Michigan, Detroit, Michigan;
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Kyong-Soon Lee
mDepartment of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada;
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Toby D. Yanowitz
nDepartment of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;
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Ulrike Mietzsch
kDepartment of Pediatrics, University of Washington, Seattle, Washington;
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Tai-Wei Wu
oDepartment of Pediatrics, Keck School of Medicine, University of Southern California and Children’s Hospital Los Angeles, Los Angeles, California;
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Nathalie L. Maitre
pDepartment of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio;
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Eugenia K. Pallotto
qDepartment of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri;
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Mark Speziale
rDepartment of Pediatrics, Rady Children’s Hospital–San Diego and University of California, San Diego, San Diego, California;
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Amit M. Mathur
sDepartment of Pediatrics, Saint Louis University, St Louis, Missouri;
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Isabella Zaniletti
tDepartment of Pediatrics, Children’s Hospital Association, Lenexa, Kansas; and
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An Massaro
uDepartment of Pediatrics, Children’s National Health System, Washington, District of Columbia
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Abstract

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 χ2: 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.

  • Accepted October 28, 2020.
  • Copyright © 2021 by the American Academy of Pediatrics

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1 Feb 2021
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Predictive Models of Neurodevelopmental Outcomes After Neonatal Hypoxic-Ischemic Encephalopathy
Eric S. Peeples, Rakesh Rao, Maria L.V. Dizon, Yvette R. Johnson, Priscilla Joe, John Flibotte, Tanzeema Hossain, Danielle Smith, Shannon Hamrick, Robert DiGeronimo, Girija Natarajan, Kyong-Soon Lee, Toby D. Yanowitz, Ulrike Mietzsch, Tai-Wei Wu, Nathalie L. Maitre, Eugenia K. Pallotto, Mark Speziale, Amit M. Mathur, Isabella Zaniletti, An Massaro, on behalf of the Children’s Hospitals Neonatal Consortium Hypoxic-Ischemic Encephalopathy Focus Group
Pediatrics Feb 2021, 147 (2) e2020022962; DOI: 10.1542/peds.2020-022962

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Predictive Models of Neurodevelopmental Outcomes After Neonatal Hypoxic-Ischemic Encephalopathy
Eric S. Peeples, Rakesh Rao, Maria L.V. Dizon, Yvette R. Johnson, Priscilla Joe, John Flibotte, Tanzeema Hossain, Danielle Smith, Shannon Hamrick, Robert DiGeronimo, Girija Natarajan, Kyong-Soon Lee, Toby D. Yanowitz, Ulrike Mietzsch, Tai-Wei Wu, Nathalie L. Maitre, Eugenia K. Pallotto, Mark Speziale, Amit M. Mathur, Isabella Zaniletti, An Massaro, on behalf of the Children’s Hospitals Neonatal Consortium Hypoxic-Ischemic Encephalopathy Focus Group
Pediatrics Feb 2021, 147 (2) e2020022962; DOI: 10.1542/peds.2020-022962
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