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Usefulness of video recordings for validating neonatal encephalopathy exams: a population-based cohort study
  1. Juan Arnaez1,2,
  2. Cristina Vega-Del-Val1,
  3. Montesclaros Hortigüela3,
  4. Isabel Benavente-Fernández2,4,5,6,
  5. Miriam Martínez-Biarge7,
  6. Carlos Ochoa Sangrador8,
  7. Alfredo Garcia-Alix2,9,10
  8. IC-HIE Study Group
    1. 1 Neonatology, Hospital Universitario de Burgos, Burgos, Spain
    2. 2 NeNe Foundation, Madrid, Spain
    3. 3 Neuropediatrics, Hospital Universitario de Burgos, Burgos, Spain
    4. 4 Neonatology, Puerta del Mar Universtity Hospital, Cadiz, Spain
    5. 5 Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
    6. 6 Area of Paediatrics, Department of Child and Mother Health and Radiology, Faculty of Medicine, University of Cádiz, Cádiz, Spain
    7. 7 Pediatrics, Imperial College London, London, UK
    8. 8 Pediatrics, Hospital Virgen de la Concha, Zamora, Spain
    9. 9 Institut de Recerca Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain
    10. 10 University of Barcelona, Barcelona, Spain
    1. Correspondence to Dr Juan Arnaez, Neonatology, Hospital Universitario de Burgos, Avda Islas Baleares, 09006, Burgos, Spain; juan.arnaez{at}


    Objective To determine the usefulness of video recordings for validating neonatal encephalopathy (NE) exams.

    Design Population-based prospective cohort study. NE was assessed and recorded at 1, 3 and 5 hours after birth by the attending physician. Recordings were reviewed blindly after the recruitment period by two specialists. Outcome was assessed at 36 months of age.

    Setting Twelve intensive care units in Spain.

    Patients Infants of ≥35 weeks’ gestational age with perinatal asphyxia.

    Main outcomes measures Weighted kappa to measure disagreement between the two specialists and between the attending physician and the specialists’ classification agreed on by consensus. Regression models to test the association of disagreement on NE assessment and outcome.

    Results Of the 32 325 liveborn infants, 217 met the inclusion criteria. Video-recordings were not available for 43 infants (20%). Weighted kappa statistic was 0.74 (95% CI 0.67 to 0.81) between the specialists and the attending physicians. Disagreement occurred in 93 of the 417 (22%) videos, specifically in 39 (14%), 43 (47%), 11 (34%) and 0 exams categorised as no, mild, moderate and severe NE, respectively. According to the specialist consensus assessment, there was disagreement on the therapeutic hypothermia decision in 10 infants.

    When there was consensus among the specialists assessing a more severe NE degree compared with the attending physicians in 170 infants, those infants had lower cognitive scores with a median of −5.33 points (95% CI −9.85 to −8.16; p=0.02).

    Conclusions This study supports the feasibility and benefit of using video recordings to identify NE in infants with perinatal asphyxia.

    • neonatology
    • neurology
    • technology

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    • JA and AG-A are joint first authors.

    • Twitter @isabenaventef

    • Collaborators M Miranda, A Cilla, C Bustamante, J Suárez, and C. De Frutos (Hospital Universitario de Burgos); F Rubio, M F Marrero, A J Martín, S Rupérez and A M Jiménez (Complejo Asistencial de Ávila); A Remesal (Complejo Asistencial Universitario de Salamanca), S Marín and R Izquierdo (Hospital Rio Hortega de Valladolid); D Mata (Complejo Asistencial Universitario de León); S Calleja (Complejo Asistencial de Segovia); M B Fernández and Y Ruiz (Hospital San Pedro de Logroño); V Marugán (Complejo Asistencial de Zamora); A Peña and R Romero (Complejo Asistencial de Soria); L D Moreno (Hospital El Bierzo).

    • Contributors JA and AG-A designed and conceptualised the study, analysed and interpreted the data and drafted the manuscript for intellectual content of the paper. CV-D-V played a major role in the acquisition of data and vouched for its accuracy and completeness, and reviewed and revised the manuscript. IB-F and COS analysed and interpreted the data and participated in the drafting of the manuscript. MH and MM-B contributed to the design of the neurodevelopmental evaluation of the study cohort and critically reviewed the manuscript. Authors named in the ‘IC-HIE Study Group’ played a major role in the recruitment of patients, administering of exams, data collection and reviewed and revised the manuscript.

    • Funding Financial support was provided by two funds: Ernesto Sánchez Villares Foundation (FESV 11/2012 and 09/2014) and Castilla-León Regional Health Authority (GRS 828/A/13).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The Clinical Research Ethics Board at Burgos Hospital approved the study (Protocol Number 916).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Data are available on reasonable request.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.