Clinical signs predict 30-month neurodevelopmental outcome after neonatal encephalopathy Steven P. Miller, MD, CM, a,b Beatrice Latal, MD, a Howard Clark, MD, b Alison Barnwell, MD, a David Glidden, PhD, c A. James Barkovich, MD, a,b,d Donna M. Ferriero, MD, a,b J. Colin Partridge, MD, MPH b, * Departments of Neurology, a Pediatrics, b Biostatistics, c and Radiology, d University of California at San Francisco, San Francisco, Calif Received May 2, 2003; revised June 26, 2003; accepted July 15, 2003 – Objective: This study was undertaken to determine the value of a neonatal encephalopathy score (ES) and the presence of seizures for predicting 30-month neurodevelopmental outcome. Study design: In a cohort study, 68 term newborn infants with encephalopathy were evaluated with an ES based on alertness, feeding, tone, respiratory status, reflexes, and seizure activity (range: 0-6). Seizures were noted as present or absent clinically. Significant cognitive deficits (Mental Development Index !70), motor disability (spastic triplegia/quadriplegia), or death were abnormal outcomes. Results: Twenty-two newborn infants (32%) had abnormal outcomes. With the use of maximum ES and presence of seizures from days 1 to 3 of life, 87% of newborn infants were correctly clas- sified (area under receiver operating curve 0.93). By using ES and presence of seizures on day 1 only, 87% of newborn infants were correctly classified (area under receiver operating curve 0.89). Conclusion: The severity of neonatal encephalopathy and the presence of seizures are valuable predictors of 30-month neurodevelopmental outcome, as early as the first day of life. Ó 2004 Elsevier Inc. All rights reserved. KEY WORDS Neonatal encephalopathy Seizures Hypoxia-ischemia Encephalopathy score – Neonatal encephalopathy remains a major cause of neurodevelopmental disability in term infants, occurring in 1 to 2 per 1000 live term births. 1 The term hypoxic- ischemic encephalopathy has also been used to describe this clinical condition, but it is misleading because many of the cases of neonatal encephalopathy have not ex- perienced documented hypoxic-ischemic insult. 2 Ap- proximately 15% to 20% of infants with neonatal encephalopathy will die during the newborn period, and of the survivors, 25% will sustain permanent clinical def- icits. 3,4 Because neonatal encephalopathy is a heteroge- neous disorder with several antenatal and intrapartum risk factors, the prediction of long-term neurodevelop- mental outcome after this state remains challenging. 5,6 This study was carried out in part in the Pediatric Clinical Research Center, Moffitt Hospital, University of California, San Francisco, with funds provided by the National Center for Research Resources, grant No. 5 M01 RR-01271, US Public Health Service, by National Institutes of Health grant No. NS35902, and the Canadian Institutes of Health Research. * Reprint requests: J. Colin Partridge, MD, MPH, Neonatal Brain Disorders Center, University of California, San Francisco, Mailstop 6E, Pediatrics, Department of Pediatrics, San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94110. E-mail: cpartridge@sfghpeds.ucsf.edu www.elsevier.com/locate/ajog American Journal of Obstetrics and Gynecology (2004) 190, 93e9 0002-9378/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved. doi:10.1016/S0002-9378(03)00908-6