Evolution of the Sarnat exam and association with 2-year outcomes in infants with moderate or severe hypoxic-ischaemic encephalopathy: a secondary analysis of the HEAL Trial.

Mietzsch, Ulrike; Kolnik, Sarah E; Wood, Thomas Ragnar; Natarajan, Niranjana; Gonzalez, Fernando F; Glass, Hannah; Mayock, Dennis E; Bonifacio, Sonia L; Van Meurs, Krisa; Comstock, Bryan A; Heagerty, Patrick J; Wu, Tai-Wei; Wu, Yvonne W; Juul, Sandra E

Mietzsch, Ulrike; Kolnik, Sarah E; Wood, Thomas Ragnar; Natarajan, Niranjana; Gonzalez, Fernando F; Glass, Hannah; Mayock, Dennis E; Bonifacio, Sonia L; Van Meurs, Krisa; Comstock, Bryan A; Heagerty, Patrick J; Wu, Tai-Wei; Wu, Yvonne W; Juul, Sandra E.

Mietzsch U; Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA mietzu@uw.edu.
Kolnik SE; Pediatrics, Division of Neonatology, Seattle Children's Hospital, Seattle, Washington, USA.
Wood TR; Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA.
Natarajan N; Pediatrics, Division of Neonatology, Seattle Children's Hospital, Seattle, Washington, USA.
Gonzalez FF; Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA.
Glass H; Child Neurology, University of Washington School of Medicine, Seattle, Washington, USA.
Mayock DE; Neurology, Division of Child Neurology, Seattle Children's Hospital, Seattle, Washington, USA.
Bonifacio SL; Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, USA.
Van Meurs K; Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA.
Comstock BA; Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA.
Heagerty PJ; Neurology, University of California San Francisco School of Medicine, San Francisco, California, USA.
Wu TW; Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA.
Wu YW; Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington, USA.
Juul SE; Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California, USA.

Arch Dis Child Fetal Neonatal Ed ; 109(3): 308-316, 2024 Apr 18.

Article en En | MEDLINE | ID: mdl-38071538

ABSTRACT

ABSTRACT

OBJECTIVE:

To study the association between the Sarnat exam (SE) performed before and after therapeutic hypothermia (TH) and outcomes at 2 years in infants with moderate or severe hypoxic-ischaemic encephalopathy (HIE).

DESIGN:

Secondary analysis of the High-dose Erythropoietin for Asphyxia and EncephaLopathy Trial. Adjusted ORs (aORs) for death or neurodevelopmental impairment (NDI) based on SE severity category and change in category were constructed, adjusting for sedation at time of exam. Absolute SE Score and its change were compared for association with risk for death or NDI using locally estimated scatterplot smoothing curves.

SETTING:

Randomised, double-blinded, placebo-controlled multicentre trial including 17 centres across the USA. PATIENTS 479/500 enrolled neonates who had both a qualifying SE (qSE) before TH and a SE after rewarming (rSE).

INTERVENTIONS:

Standardised SE was used across sites before and after TH. All providers underwent standardised SE training. MAIN OUTCOME

MEASURES:

Primary outcome was defined as the composite outcome of death or any NDI at 22-36 months.

RESULTS:

Both qSE and rSE were associated with the primary outcome. Notably, an aOR for primary outcome of 6.2 (95% CI 3.1 to 12.6) and 50.3 (95% CI 13.3 to 190) was seen in those with moderate and severe encephalopathy on rSE, respectively. Persistent or worsened severity on rSE was associated with higher odds for primary outcome compared with those who improved, even when qSE was severe.