The predictive value of history, examination, Glasgow Coma Scale (GCS) scores, EEG and sensory evoked potentials (SEP) in the prognosis of children with acute hypoxic-ischemic encephalopathy (HIE) was evaluated at the University Hospital of Lille, France. Of 53 consecutive children who were mechanically ventilated for HIE, 12 had died at 24 hours after admission, 3 were awake, and 42 showed impaired consciousness or were in coma (GCS <8).

In the 42 with uncertain prognosis, outcome was good in 12 and mild or moderate disability in 4 patients (a favorable outcome in 38%), and severe disability in 7 patients; 19 ultimately died. Predictors of an unfavorable outcome included: 1) an initial cardiopulmonary resuscitation duration longer than 10 minutes; 2) a GCS <5 at 24 hrs after admission; 3) EEG showing a discontinuous pattern and spikes or epileptiform pattern; and 4) bilateral absence of the N20 wave on SEPs. [1]

COMMENT. At 24 hours after birth, clinical signs, the GCS, EEG and SEPs permit early prediction of prognosis of children with HIE.

Microcephaly after HIE may be predicted by serial head circumference measurements between birth and 4 months of age. A decrease in HC ratios of >3.1% by 4 months correlates with development of microcephaly and neurologic sequelae before 18 months. (see Progress in Pediatric Neurology III, 1997;p396).