Prospective Research in Infants With Mild Encephalopathy

Completed

Lead Sponsor: McGill University Health Centre/Research Institute of the McGill University Health Centre

Brief Summary: A multicenter observational pilot study will be conducted to determine the natural history of infants with early diagnosis (≤ 6 hrs of age) of mild neonatal encephalopathy (NE) who are not qualified for therapeutic hypothermia. The intervention includes: neurologic examination by using modified Sarnat score at ≤ 6 hrs of age, 24 hrs and before discharge home, amplitude-integrated electroencephalography (aEEG) at 6 ± 3 hrs of age, brain MRI at before discharge home to 30 days of age and follow-up at 18-22 months of age. Primary outcome is the percentage of mild NE infants with evidence of brain injury defined by the presence of at least 1 abnormality of brain MRI, aEEG or neurologic examination in the neonatal period. Secondary outcome is the percentage of brain MRI, aEEG and neurological exam abnormalities, seizure, length of hospital stay, need of gavage feeds or gastrostomy at discharge home, death and long-term outcome.

Detailed Description: Globally, an estimated 1.8 to 7.7 infants per 1000 live term births suffer from perinatal asphyxia, which remains an important cause of neonatal encephalopathy (NE) and neurodevelopmental impairment. Over the last six years, several randomized control trials have demonstrated that prolonged and moderate therapeutic hypothermia (TH) reduces the rate of death or disability at 18 months of age among infants who survived. In these trials, infants were eligible if there was evidence of perinatal hypoxia-ischemia and a moderate or severe degree of encephalopathy on neurological evaluation performed at ≤ 6 hrs of age. However, it has been recognized that the level of NE may change over time. Preliminary and unpublished observations from our group indicated that some infants who were not classified as moderate or severe NE had neurological abnormalities at discharge or evidence of brain injury on MRI performed during the neonatal period. Unfortunately, precise data on the outcomes of this specific population is not clear. Since TH is not offered to this population, the outcomes of infants that do not qualify for TH based on neurological evaluation performed ≤ 6 hrs of life requires a more precise investigation.

Recruitment & Eligibility

Inclusion Criteria

Infants with birth weight > or = 1800g and gestational age > or = 36 weeks AND
Admission to neonatal intensive care unit (NICU) for possible hypothermia at < or = 6hr of life

Exclusion Criteria

Infants with normal neurological evaluation
Major congenital abnormalities
Refusal of informed consent
Infants who receive passive or active cooling prior to the NICU admission
Infants that develop seizures or moderate/severe NE within the first 24 hr of life and are initiated on therapeutic hypothermia after 6 hr of life.

Arm && Interventions

Group	Intervention	Description
Mild NE	Neurologic examination	Infants with evidence of a perinatal event and NE who do not qualify for therapeutic hypothermia.

Primary Outcome Measures

Name	Time	Method
Percentage of Infants With Evidence of Neurological Dysfunction, Brain Injury and/or Abnormality.	1 month	Evidence of neurological dysfunction/injury/abnormality will be defined by any of these 3 criteria, as follows: 1. MRI = Brain MRI score of pattern of injury (NICHD-NRN) \> 0, 2. aEEG = abnormal background pattern on aEEG (voltage or background pattern) at 6 ± 3 hrs of age. 3. Any abnormality on the neurological at discharge exam.

Secondary Outcome Measures

Name	Time	Method
Length of Hospital Stay	Participants will be followed for the duration of hospital stay, an expected average of 3 days
Percentage of Infants With Seizures	Participants will be followed for the duration of hospital stay, an expected average of 3 days	Development of clinical or electrographic seizures
Mortality Rate	Participants will be followed for the duration of hospital stay, an expected average of 3 days	Death during the hospitalization
Percentage of Infants Who Need Gavage Feeds or Gastrostomy at Discharge Home	Participants will be followed for the duration of hospital stay, an expected average of 3 days

Locations (7): University of Texas Southwestern
🇺🇸
Dallas, Texas, United States
The Ohio Stage University - Nationwide Children's Hospital
🇺🇸
Columbus, Ohio, United States
Brown University
🇺🇸
Providence, Rhode Island, United States
Imperial College London
🇬🇧
London, United Kingdom
Montreal Children's Hospital
🇨🇦
Montreal, Quebec, Canada
Mahidol University - Ramathibodi Hospital
🇹🇭
Bangkok, Thailand
Wayne State University
🇺🇸
Detroit, Michigan, United States