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Avaliação do valor preditivo da escala de Thompson no prognóstico de recém-nascidos de termo com encefalopatia hipóxico-isquémia sob hipotermia induzida
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Introdução e Objetivo: A Encefalopatia Hipóxico-Isquémica (EHI) é uma causa importante de morbilidade e mortalidade. Através de uma avaliação clínica, a escala de Thompson permite aferir o prognóstico neurológico do recém-nascido (RN) com clínica de EHI. Contudo, esta escala foi elaborada previamente à introdução do tratamento com hipotermia induzida. Pretende-se avaliar o valor preditivo da escala de Thompson no prognóstico do RN de termo com EHI, durante a realização de hipotermia induzida. Métodos: Estudo observacional retrospetivo, através da consulta, registo e análise de dados clínicos e demográficos. Durante um período de aproximadamente dez anos, foram avaliados RNs com diagnóstico de EHI, submetidos a hipotermia induzida no CHULN-HSM. Foram definidos quatro grupos de outcome possível com base nos dados obtidos na ressonância magnética crânio-encefálica (RM-CE) e eletroencefalograma de amplitude integrada (aEEG) - favorável, intermédio, desfavorável ou morte - tendo sido aplicados testes estatísticos de Kruskal-Wallis e comparações múltiplas através do método de pairwise, com correção de Bonferroni. Resultados: Analisaram-se 99 RNs (66 sexo masculino e 33 do sexo feminino), com média de idade gestacional de 39±2 semanas. Quase metade (47,5%) dos RNs analisados apresentavam clínica à admissão de EHI grau II (moderada). O valor da escala de Thompson à admissão que se constatou com maior frequência foi de 12. Adicionalmente, verificou-se que existe uma diferença estatisticamente significativa na distribuição dos valores da escala de Thompson nos diferentes grupos de outcome possíveis. Conclusão: Verificou-se que a escala de Thompson é um instrumento útil de avaliação clínica, mesmo em RNs a realizarem hipotermia induzida e valores mais elevados estão associados a outcome adversos, nomeadamente, desfavorável ou morte. Seria importante a realização de um estudo multicêntrico, com o objetivo de criar um modelo de prognóstico, que permitisse avaliar o valor relativo de cada parâmetro da escala de Thompson.
Introduction and Objectives: Hypoxic-ischemic encephalopathy (HIE) is an important cause of mortality and morbidity. The Thompson score, based on a clinical evaluation, the Thompson score provides predictive capabilities of the neurologic neonatal outcome. However, this score was developed before the introduction of therapeutical hypothermia in newborns. The purpose of this study is to assess the predictive value of the Thompson score for neurological outcome in newborns undergoing therapeutic hypothermia. Methods: The authors performed a retrospective study analyzing and recording clinical and demographic data. During a period of approximately 10 years, 99 newborns with HIE receiving therapeutic hypothermia in CHULN-HSM were included in this study. Four different outcomes were established – favorable, intermediate, reserved and death. For statistical data analysis Kruskal-Wallis tests and multiple comparisons were applied, through the pairwise method with Bonferroni correction. Results: A total of 99 newborns (66 male and 33 female) with a mean gestational age of 39±2 weeks were analyzed. Almost half of the newborns initially presented with clinical signs of grade II HIE (moderate). The most common Thompson score at the admission of the newborn at the hospital was 12. Moreover, there was a statistically significant difference in the distribution of the Thompson score between the distinct outcome groups. Conclusion: The Thompson score is a useful clinical tool for newborns undergoing therapeutic hypothermia and a higher score can predict adverse outcome, like reserved or death. This work would benefit from a multicenter study with larger population sizes, in order to be able to create a prognosis model to assess the relative value of each parameter composing the Thompson score.
Introduction and Objectives: Hypoxic-ischemic encephalopathy (HIE) is an important cause of mortality and morbidity. The Thompson score, based on a clinical evaluation, the Thompson score provides predictive capabilities of the neurologic neonatal outcome. However, this score was developed before the introduction of therapeutical hypothermia in newborns. The purpose of this study is to assess the predictive value of the Thompson score for neurological outcome in newborns undergoing therapeutic hypothermia. Methods: The authors performed a retrospective study analyzing and recording clinical and demographic data. During a period of approximately 10 years, 99 newborns with HIE receiving therapeutic hypothermia in CHULN-HSM were included in this study. Four different outcomes were established – favorable, intermediate, reserved and death. For statistical data analysis Kruskal-Wallis tests and multiple comparisons were applied, through the pairwise method with Bonferroni correction. Results: A total of 99 newborns (66 male and 33 female) with a mean gestational age of 39±2 weeks were analyzed. Almost half of the newborns initially presented with clinical signs of grade II HIE (moderate). The most common Thompson score at the admission of the newborn at the hospital was 12. Moreover, there was a statistically significant difference in the distribution of the Thompson score between the distinct outcome groups. Conclusion: The Thompson score is a useful clinical tool for newborns undergoing therapeutic hypothermia and a higher score can predict adverse outcome, like reserved or death. This work would benefit from a multicenter study with larger population sizes, in order to be able to create a prognosis model to assess the relative value of each parameter composing the Thompson score.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Encefalopatia hipóxico-isquémica Escala de Thompson Eletroencefalograma de amplitude integrada (aEEG) Ressonância magnética crânio-encefálica (RM-CE) Hipotermia Prognóstico