Background Perinatal asphyxia may be followed by multiple organ dysfunction (MOD) and is often included in prognostication of the individual patient, but evidence of discriminating accuracy is lacking. The aim of this study was to assess whether MOD in asphyxiated neonates during therapeutic hypothermia (TH) predicts mortality or neurodevelopmental impairment (NDI) at 24 months of age and which peripartum variables are associated with the onset of MOD.
Methods A retrospective analysis of a prospective cohort study of asphyxiated newborns undergoing TH was performed. MOD was defined as dysfunction of the brain (encephalopathy) combined with two or more organ systems. Outcome was routinely assessed by standardised developmental testing at the age of 24 months. The predictive accuracy of MOD on the combined outcome and its components (death and NDI) was expressed as areas under the receiver operating characteristic curves (AUROCs). The associations of peripartum variables and development of MOD were expressed as ORs and their CIs.
Results 189 infants (median gestation 40 (range 36–42 weeks) with moderate to severe hypoxic ischaemic encephalopathy were included. 47% developed MOD. The prediction of the combined 24-month outcome or its components showed AUROCs <0.70. Associated with MOD were pH at birth (OR 0.97, CI 0.95 to 0.99), lactate at birth (OR 1.09, CI 1.04 to 1.15), Base Excess (BE) at birth (OR 0.94, CI 0.90 to 0.99) and epinephrine administration during resuscitation (OR 2.09, CI 1.02 to 4.40).
Conclusion MOD has a low discriminating accuracy in predicting mortality or NDI at 24 months age and might not be useful for prognostication. Signs of acid–base disturbance and adrenalin use at birth are associated with the development of MOD.
Data availability statement
Data are available upon reasonable request. Data generated or analysed during the study are available from the corresponding author by request.
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Collaborators Chris van den Akker, Willem P de Boode, Filip Cools, Peter H Dijk, Koen P Dijkman, Floris Groenendaal, Timo R de Haan, Sinno H P Simons, Sylke J Steggerda, Henrica L M van Straaten and Alexandra Zecic
Contributors JL prepared the database, performed the statistical analyses, prepared the data tables, drafted the initial manuscript and revised the manuscript. LdV and FG made substantial contributions to the interpretation of data, and reviewed and revised the manuscript for important intellectual content. TRdH, WO, DV and AHvK are local investigators, made substantial contributions to the concept and design of the study, had full access to all of the data in the study, take responsibility for the integrity of the data and the accuracy of the data analysis, and critically reviewed the manuscript for important intellectual content. TRdH acts as guarantor.
All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
Funding This study was funded by a project grant from The Netherlands Organization for Health Research and Development ZonMW Priority Medicines for Children (grant number 40-41500-98-9002).
Competing interests TRdH reports grants from The Netherlands Organization for Health Research and Development ZonMW during the conduct of the study.
Provenance and peer review Not commissioned; externally peer reviewed.
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