Models of association between risk factors and severe adverse outcome within 4 hours of birth were determined in 178 infants with postasphyxial hypoxic-ischemic encephalopathy (PA-HIE) admitted consecutively between 1985 and 1992 to the regional referral neonatal ICU at the Hospital for Sick Children, Toronto, Canada. Of 165 infants with known outcomes, 88 (53%) had severe adverse outcome, 48 died (42 in the first month), and 40 had severe impairment and microcephaly at 1 year. Rates of PA-HIE and severe adverse outcome were 0.4 and 0.2/1000 births; the rate of PA-cerebral palsy was 0.1/1000 births. Delayed onset of breathing, administration of chest compressions, and seizures at less than 4 hours of age were most predictive of adverse outcome. 
COMMENT. Three independent predictors in the first 4 hours after birth may be used as clinical markers of severe adverse outcome of asphyxia and HIE: apnea duration, chest compressions, age at onset of seizures. Measurements of CBF with PET during the neonatal period may also be predictive of childhood neurologic outcome.
Neonatal cerebral blood flow (CBF) and childhood IQ and neurologic outcome. A significant negative correlation between neonatal CBF and childhood IQ measured at ages 4 to 12 years was found in a study at Washington University School of Medicine, St Louis, MO. The mean neonatal CBF in 8 with abnormal childhood neurologic outcome was higher than in 8 with normal neurologic evaluations. Higher CBF correlated with lower IQ.