Predicting Outcomes in Neonatal Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia: Prognostic Values of Selected Real-World Markers from a Single- Centre Study

Abstract Background To verify the accuracy and reliability of clinically applicable prognostic markers assessed by neonatologists—specifically, background amplitude-integrated electroencephalography (aEEG) at 24 and 36 hours and the presence of abnormal posterior limb of the internal capsule (PLIC) signaling on magnetic resonance imaging (MRI)—for predicting mortality and long-term morbidity in newborns undergoing therapeutic hypothermia. Methods This retrospective cohort study included newborns admitted to a tertiary perinatal center (2009–2020) for therapeutic hypothermia. Background aEEG recordings at 24 and 36 hours of life and the presence of abnormal PLIC imaging were evaluated. The ability of these markers to predict mortality and long-term neurodevelopmental outcomes was statistically tested. Results Of the 80 infants with complete follow-up data, 15 (18.75%) died, and 17 (21.25%) had an abnormal long-term neurodevelopmental outcome. The predictive ability was as follows: aEEG at 24 hours yielded a sensitivity of 0.81 and specificity of 0.90; aEEG at 36 hours yielded a sensitivity of 0.78 and specificity of 0.83; abnormal PLIC signaling yielded a sensitivity of 0.72 and specificity of 0.77. Conclusions The tested markers demonstrate good prognostic value and are readily applicable in routine clinical practice for multimodal prognostication without requiring highly specialized radiological or neurophysiological expertise.