Objectives Neonates who develop moderate to severe encephalopathy following perinatal asphyxia will benefit from therapeutic hypothermia. Current National Institute of Child Health and Human Development (NICHD) criteria for identifying encephalopathic neonates needing therapeutic hypothermia has high specificity. This results in correctly identifying neonates who have already developed moderate to severe encephalopathy but miss out many potential beneficiaries who progress to develop moderate to severe encephalopathy later. The need is therefore not just to diagnose encephalopathy, but to predict development of encephalopathy and extend the therapeutic benefit for all eligible neonates. The primary objective of the study was to develop and validate the statistical model for prediction of moderate to severe encephalopathy following perinatal asphyxia and compare with current NICHD criteria. Methods The study was designed as prospective observational study. It was carried out in a single center Level 3 perinatal unit in India. Neonates>35 weeks of gestation and requiring resuscitation at birth were included. Levels of resuscitation and blood gas lactate were used to determine the pre-test probability, Thompson score between 3 and 5 h of life was used to determine post-test probability of developing encephalopathy. Primary outcome measure: Validation of Prediction of Encephalopathy in Perinatal Asphyxia (PEPA) score by Holdout method. Results A total of 55 babies were included in the study. The PEPA score was validated by Holdout method where the fitted receiver-operating characteristic (ROC) area for the training and test sample were comparable (p=0.758). The sensitivity and specificity of various PEPA scores for prediction of encephalopathy ranged between 74 and 100% in contrast to NICHD criteria which was 42%. PEPA score of 30 had a best combination of sensitivity and specificity of 95 and 89% respectively. Conclusions PEPA score has a higher sensitivity than NICHD criteria for prediction of Encephalopathy in asphyxiated neonates.

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围产期窒息评分预测脑病：达到未达到

目的 围产期窒息后出现中度至重度脑病的新生儿将受益于治疗性低温。目前美国国家儿童健康与人类发展研究所 (NICHD) 用于识别需要治疗性低温治疗的脑病新生儿的标准具有很高的特异性。这导致正确识别已经发展为中度至重度脑病的新生儿，但会错过许多后来发展为中度至重度脑病的潜在受益者。因此，不仅需要诊断脑病，还需要预测脑病的发展并扩大所有符合条件的新生儿的治疗益处。该研究的主要目的是开发和验证用于预测围产期窒息后中度至重度脑病的统计模型，并与当前的 NICHD 标准进行比较。方法本研究设计为前瞻性观察性研究。它是在印度的一个中心三级围产期进行的。包括> 35 周妊娠和出生时需要复苏的新生儿。复苏和血气乳酸水平用于确定前测概率，使用生命 3 至 5 小时之间的 Thompson 评分确定发生脑病的后测概率。主要结果测量：通过 Holdout 方法验证围产期窒息 (PEPA) 评分中脑病的预测。结果 共有 55 名婴儿被纳入研究。PEPA 分数通过 Holdout 方法进行验证，其中训练和测试样本的拟合接收器操作特征 (ROC) 区域具有可比性 (p = 0.758)。与 NICHD 标准 42% 相比，各种 PEPA 评分预测脑病的敏感性和特异性介于 74% 和 100% 之间。PEPA 评分为 30，灵敏度和特异性的最佳组合分别为 95% 和 89%。结论 PEPA评分预测窒息新生儿脑病的敏感性高于NICHD标准。PEPA 评分为 30，灵敏度和特异性的最佳组合分别为 95% 和 89%。结论 PEPA评分预测窒息新生儿脑病的敏感性高于NICHD标准。PEPA 评分为 30，灵敏度和特异性的最佳组合分别为 95% 和 89%。结论 PEPA评分预测窒息新生儿脑病的敏感性高于NICHD标准。