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Licensed Unlicensed Requires Authentication Published by De Gruyter April 15, 2021

Prediction of encephalopathy in perinatal asphyxia score: reaching the unreached

  • Srinivasa Murthy Doreswamy ORCID logo EMAIL logo and Amulya Ramakrishnegowda



Neonates who develop moderate to severe encephalopathy following perinatal asphyxia will benefit from therapeutic hypothermia. Current National Institute of Child Health and Human Development (NICHD) criteria for identifying encephalopathic neonates needing therapeutic hypothermia has high specificity. This results in correctly identifying neonates who have already developed moderate to severe encephalopathy but miss out many potential beneficiaries who progress to develop moderate to severe encephalopathy later. The need is therefore not just to diagnose encephalopathy, but to predict development of encephalopathy and extend the therapeutic benefit for all eligible neonates. The primary objective of the study was to develop and validate the statistical model for prediction of moderate to severe encephalopathy following perinatal asphyxia and compare with current NICHD criteria.


The study was designed as prospective observational study. It was carried out in a single center Level 3 perinatal unit in India. Neonates>35 weeks of gestation and requiring resuscitation at birth were included. Levels of resuscitation and blood gas lactate were used to determine the pre-test probability, Thompson score between 3 and 5 h of life was used to determine post-test probability of developing encephalopathy. Primary outcome measure: Validation of Prediction of Encephalopathy in Perinatal Asphyxia (PEPA) score by Holdout method.


A total of 55 babies were included in the study. The PEPA score was validated by Holdout method where the fitted receiver-operating characteristic (ROC) area for the training and test sample were comparable (p=0.758). The sensitivity and specificity of various PEPA scores for prediction of encephalopathy ranged between 74 and 100% in contrast to NICHD criteria which was 42%. PEPA score of 30 had a best combination of sensitivity and specificity of 95 and 89% respectively.


PEPA score has a higher sensitivity than NICHD criteria for prediction of Encephalopathy in asphyxiated neonates.

Corresponding author: Dr. Srinivasa Murthy Doreswamy, MBBS, MD (Paediatrics), MRCPCH (UK), Fellowship in Neonatal and Perinatal Medicine, McMaster University, Hamilton, Canada; Department of Pediatrics, JSS Academy of Higher Education and Research, JSS Medical College, Mysuru, Karnataka, 570001, India; and 70, PRAKRUTHI, BEML 2nd Stage, Rajarajeshwari Nagara, Mysuru, Karnataka, 570022, India, Phone: +91 9980941161, E-mail:

Funding source: Self funded study


We sincerely thank Dr. Mike Marrin, Associate professor in pediatrics at McMaster University children hospital at Hamilton, Ontario, Canada for his initial inputs in formulating the research question.

  1. Research funding: This is a self funded study.

  2. Author contributions: SMD framed the research question, formulated the study design, did the statistical analysis, and contributed to the manuscript. ARG reviewed the literature, collected the data, and contributed to manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Institutional Ethical committee of JSS Medical College approved this study (JSSMC/PG/4700/2017–2018).


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2020-06-28
Accepted: 2021-03-18
Published Online: 2021-04-15
Published in Print: 2021-07-27

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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