Predicting death or long-term neurodevelopmental outcome in term newborns after hypoxic ischemic encephalopathy

Hypoxic-ischemic encephalopathy after perinatal asphyxia is a severe neonatal disease with a high mortality and morbidity rate despite recent improvements in medical care in the Neonatal Intensive Care Unit. In the diagnostic and prognostic workup of these patients, a wide range of biochemical, neurophysiological and radiological tests is performed. Although many of these predictive parameters have been studied, an internationally accepted, validated prediction model to predict the long-term neurodevelopmental outcome in this high-risk population is currently lacking. This thesis aimed to investigate and contribute to the current evidence on long-term outcome prediction of newborns with hypoxic ischemic encephalopathy treated with controlled therapeutic hypothermia. The systematic review performed confirmed that to date there is no clinically applicable multivariate prediction model available for long-term outcome in these infants. The additional studies showed that the MRI Weeke score is a reliable predictor of outcome and should be implemented in clinical practice. It was demonstrated that multiple organ dysfunction should not be taken into account when predicting or discussing the outcome of these infants. Neither the presence of seizures, nor the severity of seizures (described by the number of anti-epileptic drugs needed) are associated with the combined outcome up until the age of five years after correction for important confounders. Finally, a novel prediction model for the combined outcome death or NDI at two years of age was build and internally validated.