THE LOGISTIC SCORE: A CRITERION FOR HYPOTHERMIA AFTER BIRTH ASPHYXIA?
| Autor: | D. Amrom, J. L. Wayenberg, J. De Buyst, D. Vermeylen |
|---|---|
| Rok vydání: | 2006 |
| Předmět: | |
| Zdroj: | Neuropediatrics. 37 |
| ISSN: | 1439-1899 0174-304X |
| DOI: | 10.1055/s-2006-945609 |
| Popis: | Objectives: To identify during the first hour of life the term asphyxiated neonates who will further develop moderate or severe neonatal encephalopathy (NE), as potential candidates for hypothermia. Methods: Birth asphyxia was defined as both clinical distress and metabolic acidosis (arterial base deficit (BD30) >10 mEq/l) at 30' of life. For each patient we gave at 30' of life a neurological score (NS) graded from 0 to 6 according to their level of consciousness (normal/hyperalertness=2, lethargy=1, stupor=0), respiration pattern (regular=2, irregular=1, absent=0) and neonatal reflexes (normal/increased=2, depressed=1, absent=0), and calculated the logistic score (LS), a function of BD30 and NS: (0.33*BD30)–(1.06*NS). Patients were divided into two groups according to their neonatal neurological course: normal or mild NE versus moderate or severe NE. The ROC methodology was applied in order to analyze the ability of LS to correctly classify patients into the two groups. Results: Among the 84 asphyxiated patients studied, moderate NE occurred in 8 and severe NE in another 7. The area under the ROC curve (±SE) is 95.8±3.6%. The apex of the curve corresponds to LS=1. At this threshold, the LS provides 93.3% sensitivity and 89.9% specificity. The positive predictive value is 66.7% which means that two thirds of asphyxiated term infants with LS>1 developed moderate or severe NE. The positive predictive value reaches 100% for LS>4. At this threshold, the sensitivity is only 53.3%. Conclusion: The logistic score is predictive for the neonatal neurological evolution after birth asphyxia and may help to select the high risk patients candidates for hypothermia. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|