The predictive accuracy of hypoxic scoring for prediction of adverse outcome in neonates born with asphyxia


  • Muhammad Saqib Department of Paediatrics, Indus Health Care, Network, Pakistan
  • Safeer A. Jamil Department of Paediatrics, Children Hospital, Lahore, Pakistan
  • Usman Arif Department of Paediatrics, Indus Health Care, Network, Pakistan
  • Zubda Anwar Department of Obstetrics and Gynaecology, Dr. Sulaiman Alhabib Hospital, Alkhobar, Saudi Arabia
  • Sarosh Waheed Department of Paediatrics, Children Hospital, Lahore, Pakistan
  • Munibah Bashir Department of Paediatrics, Fatima Memorial Hospital, Lahore, Pakistan
  • Maham Javed Department of Morbid Anatomy and Histopathology, University of Health Sciences, Lahore, Pakistan



Adverse outcome, Asphyxia, Hypoxic scoring, Neonates, Predictive accuracy


Background: Birth asphyxia is a major contributor to neonatal mortality. Fetal hypoxia followed by asphyxia is common cause of brain injury in term infants. Hypoxia score has shown to be accurate enough to predict adverse outcome in asphyxiated neonates. But controversies exist regarding predictive accuracy of hypoxia score. So we conducted this study. Objective to assess the predictive accuracy of hypoxic scoring for prediction of adverse outcome in neonates born with asphyxia.

Methods: 170 neonates were screed for hypoxia score. Neonates were labelled as positive or negative. Then all neonates were followed-up for 7 days. If neonate died within 7days, then case was confirmed as positive or negative. Data was analysed by using SPSS 20. 2x2 table was developed to calculate sensitivity, specificity, PPV, NPV and predictive accuracy of hypoxia score.

Results: The mean Apgar score at birth was 5.01±0.83. The sensitivity of hypoxia score was 87.8%, specificity was 90.9%, PPV was 90%, NPV was 88.9% while predictive accuracy was 89.4% taking actual adverse outcome as gold standard.

Conclusions: The predictive accuracy of hypoxia score was high for prediction of adverse outcome in asphyxiated neonates.


Zhou WH, Cheng GQ, Shao XM, Liu XZ, Shan RB, et al. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr. 2010;157(3):367-72.

Horn AR, Swingler GH, Myer L, Linley LL, Raban MS, Joolay Y, et al. Early clinical signs in neonates with hypoxic ischemic encephalopathy predict an abnormal amplitude-integrated electroencephalogram at age 6 hours. BMC Pediatr. 2013;13(1):52.

Kurinczuk JJ, White-Koning M, Badawi N. Epidemiology of neonatal encephalopathy and hypoxic–ischaemic encephalopathy. Early Human Development. 2010;86(6):329-38.

Horn AR, Swingler GH, Myer L, Harrison MC, Linley LL, Nelson C, et al. Defining hypoxic ischemic encephalopathy in newborn infants: benchmarking in a South African population. J Perinat Med. 2013;41(2):211-7.

Padayachee N, Ballot DE. Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa. South African J Child Health. 2013;7(3):89-94.

Tagin MA, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA. Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolescent Med. 2012;166(6):558-66.

Thompson CM, Puterman AS, Linley LL, Hann FM, Van der Elst CW, Molteno CD ,et al. The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome. Acta Paediatr. 1997;86(7):757-61.

Mwakyusa SD, Manji KP, Massawe AW. The hypoxic ischaemic encephalopathy score in predicting neurodevelopmental outcomes among infants with birth asphyxia at the Muhimbili National Hospital, Dar-es-Salaam, Tanzania. J Trop Pediatr. 2008;55(1):8-14.

Merchant N, Azzopardi D. Early predictors of outcome in infants treated with hypothermia for hypoxic–ischaemic encephalopathy. Develop Med Child Neurol. 2015;57:8-16.

Perez JM, Golombek SG, Sola A. Clinical hypoxic-ischemic encephalopathy score of the Iberoamerican Society of Neonatology (Siben): A new proposal for diagnosis and management. Revista da Associação Médica Brasileira. 2017;63(1):64-9.

Agut T, León M, Rebollo M, Muchart J, Arca G, Garcia-Alix A. Early identification of brain injury in infants with hypoxic ischemic encephalopathy at high risk for severe impairments: accuracy of MRI performed in the first days of life. BMC Pediatr. 2014;14(1):177.

Ahearne CE, Boylan GB, Murray DM. Short and long term prognosis in perinatal asphyxia: An update. World J Clini Pediatr. 2016;5(1):67.

Ilah BG, Aminu MS, Musa A, Adelakun MB, Adeniji AO, Kolawole T. Prevalence and risk factors for perinatal asphyxia as seen at a specialist hospital in Gusau, Nigeria. Sub-Saharan African J Med. 2015;2(2):64.

Sabir H, Cowan FM. Prediction of outcome methods assessing short-and long-term outcome after therapeutic hypothermia. In Seminars in Fetal and Neonatal Med. 2015;20(2):115-21.

Weeke LC, Groenendaal F, Mudigonda K, Blennow M, Lequin MH, Meiners LC, et al. A novel magnetic resonance imaging score predicts neurodevelopmental outcome after perinatal asphyxia and therapeutic hypothermia. J Pediatr. 2018;192:33-40.

Dalili H, Nili F, Sheikh M, Hardani AK, Shariat M, Nayeri F. Comparison of the four proposed Apgar scoring systems in the assessment of birth asphyxia and adverse early neurologic outcomes. PloS one. 2015;10(3):1371.

Chalak LF, Sánchez PJ, Adams-Huet B, Laptook AR, Heyne RJ, Rosenfeld CR. Biomarkers for severity of neonatal hypoxic-ischemic encephalopathy and outcomes in newborns receiving hypothermia therapy. J Pediatr. 2014;164(3):468-74.

Polat M, Şimşek A, Tansuğ N, Sezer RG, Özkol M, Başpınar P, et al. Prediction of neurodevelopmental outcome in term neonates with hypoxic-ischemic encephalopathy. Europ J Paediatr Neurol. 2013;17(3):288-93.






Original Research Articles