A retrospective study of 35 term infants with post-asphyxial hypoxic-ischemic encephalopathy (HIE) was conducted at the KK Women’s and Children’s Hospital, Singapore, to determine early predictors of mortality or major motor morbidity at 18 months of age. A severe adverse outcome occurred in 23: thirteen died and ten had major neurological sequelae. Risk factors included a low 5 min Apgar score (<4), the use of adrenaline, low arterial pH (<7.1) and high base deficit (>20 mEq/L). The high base deficit and low Apgar score combined had a positive predictive value of 100%. [1]

COMMENT. The combination of a low Apgar score and high base deficit in term infants with post-asphyxial HIE is an early predictor of mortality or major neurologic sequelae.

Serum CPK and outcome of HIE. An elevated serum CPK measured within 4 hours after birth is a sensitive indicator of brain damage in asphyxiated term infants but is of limited prognostic value in assessment of neurological outcome, according to one previous report, whereas another study showed that CPK measured in cord blood correlates with outcome after asphyxia and compares favorably with imaging studies. (Progress in Pediatric Neurology I, 1991;pp 332).

Cranial ultrasonography and spectroscopy are of value in the prediction of neurodevelopmental outcome of HIE (see Progress in Pediatric Neurology II, 1994; 313-331).