Cerebral Palsy After Neonatal Encephalopathy
Bibliographic record
Abstract
In neonates with moderate or severe neonatal encephalopathy (NE), therapeutic hypothermia or “cooling” has been effective as a neuroprotective intervention in patients who meet eligibility criteria. There is hope that cooling might reduce the frequency of cerebral palsy (CP) in neonates with NE born at full term. However, there is no strategy for neuroprotection of neonates born at term with NE who do not meet eligibility criteria for therapeutic hypothermia. This study aimed to gauge the proportion of CP cases after NE that could be prevented with hypothermia treatment and to also explain the perinatal factors associated with CP after NE in patients who do not meet criteria for cooling. This study used data from the Canadian Cerebral Palsy Registry, which included children at least 2 years old who met current criteria for CP. Criteria for hypothermia treatment eligibility came from the Position Statement of the Canadian Paediatric Society and the National Institute of Child Health and Human Development randomized controlled trial of therapeutic hypothermia. To investigate variables that might separate infants who meet cooling criteria from those who do not, a series of factors (maternal, paternal, postnatal, and placental) were compared. Previous meta-analysis of randomized controlled trials found the number needed to treat to prevent 1 case of CP was 8, which was therefore used in this analysis. Of the 1001 patients enrolled in the Canadian Cerebral Palsy Registry between 1999 and 2011, 155 were 36 weeks’ gestation or greater, with a birth weight of 1800 g or greater and had moderate or severe NE. Of this cohort, 64 (41%) met cooling criteria, and 91 (59%) did not. Thirteen neonates were actually cooled: 11 who met cooling criteria (17%) and 2 who did not (2%). All 13 neonates who were cooled were born in or after 2009. In the cohort, children who met cooling criteria were more likely to have hypotonia than children who did not (P = 0.02). Between the 2 groups, there were no significant differences in antenatal maternal or paternal variables. In the group that met cooling criteria, signs of perinatal distress, including cesarean delivery, low pH, low Apgar score, or resuscitation at birth, were significantly more common (P < 0.0001). In the group that did not meet cooling criteria, shoulder dystocia was more common than in those who did meet the criteria (odds ratio, 8.8; 95% confidence interval, 1.1–71.4). Hypothermia could prevent term CP after NE in an estimated 5.1% of cases (95% confidence interval, 2.4%–6.9%). To reduce the burden of CP, it is imperative to have a better understanding of the antenatal processes underlying NE.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".