CORRELATION OF THOMPSON SCORE AND MODIFIED SARNAT STAGING IN PREDICTING EARLY NEONATAL OUTCOME IN POST ASPHYXIATED NEONATES - A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Birth asphyxia, a major cause of neonatal mortality and morbidity, is a significant global challenge, particularly in developing nations. Hypoxic-ischemic encephalopathy (HIE), a neurological syndrome resulting from perinatal asphyxia, can cause neonatal mortality or manifest later as cerebral palsy or cognitive impairment. Both the Modified Sarnat Staging and Thompson Scoring systems offer simple, non-invasive methods for early diagnosis and prognosis, which are crucial for guiding clinical decisions and parental counselling. However, the general propensity to use either technique depending on circumstances may lead to inconsistent outcomes. The aim of this study is to determine the correlation between Thompson Score and Modified Sarnat Staging in assessing the outcome in early neonatal period in post asphyxiated neonates. Material and Methods: A Prospective observational clinical study study was conducted in R. L.Jalappa hospital affiliated to Sri Devaraj Urs Medical College, a constituent of Sri Devaraj Urs Academy of Higher Education and Research. Neonates within the sample size and inclusion criteria were assessed by the same person based on Thompson and Modified Sarnat scoring and were each given a score based on both Thompson and Sarnat modified scoring. Both scores done for each neonate were correlated in assessing for early neonatal outcome in the post asphyxiated neonates. Results: Among 50 neonates, overall mortality was observed in 16% of neonates, with deaths of (4%) occurring within 24 hours, (4%) between 24-72 hours and (8%) beyond 72 hours. A significant association was found between both Thompson and Modified Sarnat scores with mortality and other outcomes such as seizures, persistent pulmonary xviii hypertension(PPHN), hypotension, deranged coagulation, thrombocytopenia, anaemia, feeding intolerance, and acute kidney injury. A fair agreement of (74%) was observed between Thompson and Modified Sarnat scores, with both scores showing significant associations with various complications and outcomes .The Receiver Operating Characteristic (ROC) curve analysis demonstrated that the Thompson score's Area under the curve (AUC) was 0.859, indicating strong predictive capability for mortality. Conclusion: The Thompson Score and Modified Sarnat Staging are effective tools for assessing hypoxic-ischemic encephalopathy severity and predicting neonatal outcomes. The Thompson Score is more accurate and reliable, especially for identifying neonates at risk for adverse outcomes. It is preferred for early assessment and management of post-asphyxiated neonates, leading to better-targeted interventions and improved neonatal care.