Differences in standardized neonatal encephalopathy exam criteria may impact therapeutic hypothermia eligibility

Brian H Walsh; Hoda El-Shibiny; Chelsea Munster; Edward Yang; Terrie E Inder; Mohamed El-Dib

doi:10.1038/s41390-021-01834-7

Differences in standardized neonatal encephalopathy exam criteria may impact therapeutic hypothermia eligibility

Pediatr Res. 2022 Sep;92(3):791-798. doi: 10.1038/s41390-021-01834-7. Epub 2021 Nov 9.

Authors

Brian H Walsh^{1

2}, Hoda El-Shibiny³, Chelsea Munster³, Edward Yang⁴, Terrie E Inder³, Mohamed El-Dib³

Affiliations

¹ Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland. brianhenry.walsh@hse.ie.
² Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA. brianhenry.walsh@hse.ie.
³ Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁴ Department of Radiology, Boston Children's Hospital, Boston, MA, USA.

PMID: 34754094
DOI: 10.1038/s41390-021-01834-7

Abstract

Background: Therapeutic hypothermia (TH) is routinely provided to those with moderate or severe neonatal encephalopathy (NE). Subtle differences exist in the standardized exams used to define NE severity. We aimed to assess if an infant's TH eligibility status differed if they were evaluated using either the NICHD/Neonatal Research Network's (NICHD-NRN) or TOBY/British Association of Perinatal Medicine's (TOBY-BAPM) neurological exam.

Methods: Encephalopathic infants ≥36 weeks with evidence of perinatal asphyxia and complete documentation of the neurological exam <6 h of age were included. TH eligibility using the NICHD-NRN and TOBY-BAPM criteria was determined based upon the documented exams.

Results: Ninety-one encephalopathic infants were included. Despite good agreement between the two exams (κ = 0.715, p < 0.001), TH eligibility differed between them (p < 0.001). A total of 47 infants were deemed eligible by at least one method-46 using NICHD-NRN and 35 using TOBY-BAPM. Of the 12 infants eligible per NICHD-NRN, but ineligible per TOBY-BAPM, two developed electrographic seizures and seven demonstrated hypoxic-ischemic cerebral injury.

Conclusions: Both the NICHD-NRN and TOBY-BAPM exams are evidence-based. Despite this, there is a significant difference in the number of infants eligible for TH depending on which exam is used. The NICHD-NRN exam identifies a greater proportion as eligible.

Impact: There are subtle differences in the NICHD-NRN and TOBY-BAPM's encephalopathy exams used to determine eligibility for TH. This results in a significant difference in the proportion of infants determined to be eligible for TH depending on which encephalopathy exam is used. The NICHD-NRN encephalopathy exam identifies more infants as being eligible for TH than the TOBY-BAPM encephalopathy exam. This may result in different rates of cooling depending on which evidence-based neurological exam for evaluation of encephalopathy a center uses.

MeSH terms

Asphyxia Neonatorum* / complications
Asphyxia Neonatorum* / diagnosis
Asphyxia Neonatorum* / therapy
Azides
Humans
Hypothermia, Induced* / methods
Hypoxia-Ischemia, Brain* / diagnosis
Hypoxia-Ischemia, Brain* / therapy
Infant
Infant, Newborn
Infant, Newborn, Diseases* / therapy

Substances

Azides
N-bromoacetyl-4-azido-L-phenylalanine methyl ester