Abstract
Perinatal hypoxic-ischemic brain injury can cause long-term neurodevelopmental impairment (NDI), including motor, cognitive, and behavioral deficits. Hypoxic-ischemic encephalopathy (HIE) affects approximately 1.3–1.7/1,000 live births. Although brain hypothermia therapy (BHT) can significantly reduce mortality and NDI in HIE, half of infants with moderate to severe HIE still experience death or NDI. Herein, we enrolled 144 infants with HIE treated with BHT at Kagoshima City Hospital, Japan between January 2000 and October 2022, of whom 100 were evaluated. Clinical data, amplitude-integrated electroencephalograms (aEEG), Thompson scores, and resuscitation data were analyzed to identify predictive factors for developmental outcomes at 18 months. Significant predictors of death cerebral palsy (CP); a developmental quotient (DQ) < 70 including low Apgar scores at 1/5/10 min; low umbilical artery pH; flat trace or continuous low voltage on aEEG; a high Thompson score; chest compressions during resuscitation; and adrenaline during resuscitation. Flat trace or continuous low voltage on aEEG, Thompson score ≥ 12, and chest compressions remained significant predictors on multivariate regression analysis. When combined, these criteria had a high sensitivity (0.704) and specificity (0.0096), with an AUC of 0.86. These factors can guide early prognostic predictions before the initiation of BHT, thereby providing critical prognostic information for treatment.