Improvement in the prediction of neonatal hypoxic-ischemic encephalopathy with the integration of umbilical cord metabolites and current clinical makers

Document Type

Journal Article

Publication Title

Journal of Pediatrics

Volume

229

First Page

175

Last Page

181.e1

PubMed ID

33039387

Publisher

Elsevier

School

Centre for Integrative Metabolomics and Computational Biology / School of Science

RAS ID

32918

Funders

Health Research Board Science Foundation Research Centre Award

Comments

O'Boyle, D. S., Dunn, W. B., O'Neill, D., Kirwan, J. A., Broadhurst, D. I., Hallberg, B., ... Murray, D. M. (2021). Improvement in the prediction of neonatal hypoxic-ischemic encephalopathy with the integration of umbilical cord metabolites and current clinical makers. The Journal of Pediatrics, 229, 175-181.e1. https://doi.org/10.1016/j.jpeds.2020.09.065

Abstract

© 2020 Objective: To validate our previously identified candidate metabolites, and to assess the ability of these metabolites to predict hypoxic-ischemic encephalopathy (HIE) both individually and combined with clinical data. Study design: Term neonates with signs of perinatal asphyxia, with and without HIE, and matched controls were recruited prospectively at birth from 2 large maternity units. Umbilical cord blood was collected for later batch metabolomic analysis by mass spectroscopy along with clinical details. The optimum selection of clinical and metabolites features with the ability to predict the development of HIE was determined using logistic regression modelling and machine learning techniques. Outcome of HIE was determined by clinical Sarnat grading and confirmed by electroencephalogram grade at 24 hours. Results: Fifteen of 27 candidate metabolites showed significant alteration in infants with perinatal asphyxia or HIE when compared with matched controls. Metabolomic data predicted the development of HIE with an area under the curve of 0.67 (95% CI, 0.62-0.71). Lactic acid and alanine were the primary metabolite predictors for the development of HIE, and when combined with clinical data, gave an area under the curve of 0.96 (95% CI, 0.92-0.95). Conclusions: By combining clinical and metabolic data, accurate identification of infants who will develop HIE is possible shortly after birth, allowing early initiation of therapeutic hypothermia.

DOI

10.1016/j.jpeds.2020.09.065

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