Table 1.
Comparison of definitions of Multi-Organ Dysfunction in Neonatal Encephalopathy.
| Shah et al. (10) | Hankins et al. (177) | Martin-Ancel et al. (11) | Perlman et al. (213) | Alsina et al. (214) | |
|---|---|---|---|---|---|
| Multi-Organ dysfunction in neonatal encephalopathy | |||||
| CVS | Hypotension treated with an inotrope for >24 h to maintain normal BP ECG evidence of transient myocardial ischaemia |
Need for inotropic support beyond 2 h post birth Elevated CK-MB isoenzyme |
Systolic and or diastolic BP <5th percentile for age and sex ECG abnormalities ECHO abnormalities |
ECG or ECHO abnormalities(values > 2 SDs fromthe mean normal values) | Troponin >1 ug/L Need for vasoactive drugs |
| Hepatic | AST or ALT> 100 IU/l during week one | Elevation of AST, ALT, LDH to 1.5 x upper normal level | Not included | Not included | GOT or GPT >100 Prothrombin activity <60% |
| Renal | Anuria or oliguria for ≥24 h and a SCr >100 mmol/l Anuria/oliguria for >36 h Any SCr >125 mmol/l Serial SCr increasing postnatally |
Elevation of SCr to ≥88.4 mmol/l Oliguria >24 h Persistent haematuria or proteinuria |
Oliguria for > 24 h ≥2+ of proteinuria Azotaemia = BUN >7 mmol/l |
Urea >7 mmol/l azotaemia SCr >90 mmol/l after post-natal D3 Oliguria (<1 ml/kg/hr) for >24 h |
Creatinine >1 mg/dl Diuresis <0.99 ml/kg/h Need for replacement therapy |
| Neuro | Not included | Clinical evidence of NE EEG abnormalities Neuroimaging abnormalities |
Abnormal Neurological exam EEG abnormalities Neuroimaging abnormalities |
Abnormal neurological exam Cranial ultrasound abnormalities |
Not included |
| Resp | Need for ventilatory support with 40% oxygen for at least the first 4 h after birth | Not included | Abnormal Silverman Score Need for 02 supplementation Need for Mechanical Ventilation |
Requirement for intubation and Mechanical Ventilation > 48 h post birth | Need for resp support due to causes other than central apnoea or pharmacological effects |
| GI | Not included | Not included | Gastric residuals, vomiting, abdominal distension/tenderness, and GI bleeding | Evidence of NEC | Not included |
| Haem | Not included | Thrombocytopenia (<100 × 109/L) Increase in nRBCs to ≥26 per 100 WBCs |
Not included | Not included | Leucocyte <4.5 or >30 mm3
Platelet <149 APTT >45 s Platelet or FFP |
Scoring systems by Shah, Hankins, Martin-Ancel, Perlman, and Alsina assess systems of Cardiovascular, Hepatic, Renal, Neurological, Gastrointestinal, and Hematological Dysfunction.
CVS, cardiovascular; Neuro, neurological; resp, respiratory; GI, gastrointestinal; Haem, hematological; BP, Blood Pressure; AST, Aspartate Amino Transferase; ALT, Alanine Amino Transferase; SCr, Serum Creatinine; CK-MB, Creatinine Kinase Muscle-Brain-Type Isoenzyme; ECG, Electrocardiographic; ECHO, Echocardiographic; SDs, Standard Deviations; NE, Neonatal Encephalopathy; EEG, Electroencephalographic; BUN, Blood Urea Nitrogen; 02, Oxygen; GI, Gastrointestinal; MV, Mechanical Ventilation; NEC, Necrotising Enterocolitis; nRBCs, Nucleated Red Blood Cells; WBCs, White Blood Cell; Glutamic oxaloacetic transaminase (GOT) Glutamic pyruvic transaminase (GPT).