The Vermont oxford neonatal encephalopathy registry: rationale, methods, and initial results

Eligible infants were？≥？36 weeks with seizures, altered consciousness (stupor, coma) during the first 72 hours of life, a 5 minute Apgar score of？≤？3, or receiving HT. Infants with central nervous system birth defects were excluded.From 2006–2010, 95 centers registered 4232 infants. Of those, 59% suffered a seizure, 50% had a 5 minute Apgar score of？≤？3, 38% received HT, and 18% had stupor/coma documented on neurologic exam. Some infants experienced more than one eligibility criterion. Only 53% had a cord gas obtained and only 63% had a blood gas obtained within 24 hours of birth, important components for determining HT eligibility. Sixty-four percent received ventilator support, 65% received anticonvulsants, 66% had a head MRI, 23% had a cranial CT, 67% had a full channel encephalogram (EEG) and 33% amplitude integrated EEG. Of all infants, 87% survived.The VON NER describes the heterogeneous population of infants with NE, the subset that received HT, their patterns of care, and outcomes. The optimal routine care of infants with neonatal encephalopathy is unknown. The registry method is well suited to identify opportunities for improvement in the care of infants affected by NE and study interventions such as HT as they are implemented in clinical practice.Neonatal encephalopathy (NE) in the term or late preterm infant is "a clinically defined syndrome of disturbed neurologic function in the earliest days of life manifested by difficulty with initiating and maintaining respiration, depression of tone and reflexes, subnormal level of consciousness, and often by seizures" [1]. NE occurs in an estimated 2–5 per 1000 live term births of which up to one quarter experience moderate or severe cerebral injury [2-4]. Between 10-40% do not survive and as many as 30% exhibit significant long-term neurodevelopmental disability [5].Randomized controlled trials (RCTs) demonstrated that hypothermic therapy (HT) may improve neurologic and developmental outcomes and reduce death and