Short and long term prognosis in perinatal asphyxia: An update

Table 1 Predictors of outcome

Predictors of outcome	Pros	Cons
Standard
Acid-base balance	Widely available test, can be measured early by scalp and cord sampling	Cannot differentiate degree of severity of injury, invasive testing
pH	Responds early to HI	Low PPV for abnormal outcome
Lactate	Better reflects metabolic mechanism	No advantage over pH
Apgar score	Quick assessment of neonatal condition at birth, non-invasive	High inter-observer variability, poor predictor of long-term outcome
Clinical examination	Non-invasive, good to track changes in clinical state as injury evolves, predictive at discharge	Requires clinical experience, affected by intubation and medications and hypothermia, poor predictor of long-term outcome
EEG/aEEG	“Gold standard”, early predictive value if normal, value of subclinical seizure detection, non-invasive	Requires resources, equipment to apply, clinical expertise to interpret
Novel
HRV	Differentiates severity of HIE, non-invasive	Requires specialist equipment
MRI/MRS	Specific patterns of injury aid prognosis, early changes apparent	Requires specialist equipment, requires transfer of sick infant to MRI machine/department, requires infant to remain still for prolonged periods
Biomarkers	Very promising in pilot studies	None validated for clinical use
Serum	Reflects systemic biochemical state	Mixed markers from cerebral and other organ dysfunction, only small volumes available, invasive testing
Cord blood	Large volumes possible, available early	Mixture of fetal and placental blood
CSF	Reflects cerebral markers	Very difficult to sample
Urine	Relatively easy to sample	Affected if significant renal disease
Proteomics	Relatively stable and easy to test	Requires specialist equipment, response to injury may be delayed
Metabolomics	Rapidly responsive to changes in biochemical state	Requires specialist equipment, highly sensitive to environmental factors
Transcriptomics	Involved in critical processes of cell cycle and cell death, very stable	Requires specialist equipment, most markers are completely novel and difficult to identify, they may also regulate multiple pathways

The current standard tools and the novel emerging techniques to predict outcome in perinatal asphyxia are outlined with their respective advantages and disadvantages. HI: Hypoxia-ischaemia; EEG: Electroencephalograph; aEEG: Amplitude-integrated electroencephalograph; HRV: Heart rate variability; MRI: Magnetic resonance imaging; MRS: Magnetic resonance spectroscopy; HIE: Hypoxic-ischaemic encephalopathy; CSF: Cerebrospinal fluid.

Table 2 Outcomes in perinatal asphyxia

Short-term
	Death
	HIE
	Seizures
Long-term
	Motor	Cerebral palsy
	Sensory	Hearing loss
		Visual impairment
	Cognitive	Episodic and working memory
		Attention
	Educational	Increased support requirements
		Lower test scores
	Behavioural	Attention
		Explosiveness
		Irritability
	Neuropsychiatric	Psychotic symptoms
	Neurodevelopmental	Autistic spectrum

A summary table of reported outcomes in perinatal asphyxia and hypoxic-ischaemic encephalopathy; HIE: Hypoxic-ischaemic encephalopathy.