Contents Chapter Topic Page Neonatology Respiratory Cardiology

F. Prognosis
a) Apgar score and mortality.
Mortality in the first year of life for premature babies.
Babies < 2500g : mortality > 80% if Apgar is 0 - 3 at 15 min.
mortality > 95% if Apgar is 0 - 3 at 20 min.
Babies > 2500 g: mortality is 50% if Apgar is 0 - 3 at 15 min.
mortality is 60% if Apgar 0 - 3 at 20 min.
Mortality very high in infants who do not breathe spontaneously at 30 min.
Risk of CP. is 60% for BW > 2500 g if Apgar is 0 - 3 at 20 min.
93% of babies with Apgar 0 at 1 min. and 0-3 at 5 min. were entirely normal
on follow-up. Therefore 15 min and 20 min score is important.
b) Severity of HIE and outcome (most accurate predictor)
No infant with mild HIE alone developed impairment. Mild encephalopathy
carries an excellent prognosis irrespective of Apgar score and parents
should be strongly reassured of excellent outcome.
The median risk for impairment is 25% in moderate NE and 92% in severe
NE.
c) CT scans done after 1st week of life.
Extensive areas of low attenuation with apparent brightness of basal ganglia
are associated with very poor prognosis.
d) Doppler U/S appears to be an accurate predictor for full term babies done after 24
hours of life.
Decrease Pourcelot’s resistivity index (PRI 3 SD of the
normal mean has a +ve predictive value for adverse outcome of 94%.
e) U/S of head can be done at discharge and at 2 - 3 weeks of life to look for
periventricular haemorrhage or periventricular leukomalacia.
f) EEG:
severe abnormalities include burst suppression, low voltage or isoelectric EEG.
moderate abnormalities include slow activity
The overall risks for death or disability were 95% for severely abnormal EEG,
64% for moderately abnormal EEG and 3 % for normal or mildly abnormal EEG 7,8
Continuous EEG monitoring in the first 6-12 hours after birth has been shown to
identify infants at risk of subsequent brain damage 9
Long term :
a. Phenobarbitone will be taken off on discharge if the child is neurologically normal
and feeds normally (by day 7-10).
b. If CNS is abnormal - the duration of phenobarbitone use is controversial.
Probably 3-6 mths. (Longer if EEG abnormal)