The dissertation is devoted to addressing an important scientific and practical problem of modern neonatology: improving the effectiveness of prognostication of outcomes of hypoxic-ischemic encephalopathy in children after therapeutic hypothermia through a comprehensive analysis of the course of the neonatal period, indicators of multiple organ dysfunction, and neuroimaging changes in comparison with the results of long-term assessment of neurodevelopment and quality of life, in order to substantiate risk-group stratification and determine further tactics of follow-up observation.
The study design included retrospective and prospective stages. During the retrospective stage, which covered the neonatal period, primary screening was performed and the cohort of examined children was formed; the dynamics of clinical manifestations of hypoxic-ischemic encephalopathy were assessed depending on the cooling method, and the frequency of adverse short-term outcomes of hypoxic-ischemic encephalopathy was evaluated.
During the prospective stage, which involved follow-up observation, the structure of long-term outcomes of hypoxic-ischemic encephalopathy after therapeutic hypothermia was studied, the possibilities of their prediction were assessed, neurodevelopment and quality of life in children were evaluated, and an approach to risk stratification of long-term outcomes was developed.
At the retrospective stage, 117 full-term newborns were examined who had signs of severe asphyxia at birth and who underwent therapeutic hypothermia in accordance with the current clinical protocols of the Ministry of Health of Ukraine.
Scientific novelty. For the first time in the studied regional cohort of term neonates after severe birth asphyxia, a comprehensive assessment of short-term and long-term outcomes of hypoxic-ischemic encephalopathy was performed under conditions of device-based and non-device therapeutic hypothermia. It was shown that device-based and non-device systemic therapeutic hypothermia, within the studied cohort, were clinically comparable in most major characteristics of the neonatal course, whereas the severity of the primary post-asphyxial injury and the degree of multiple organ dysfunction had decisive prognostic significance.
The prognostic value of the Multiple Organ Dysfunction in Neonatal Encephalopathy score, destructive changes in brain tissue, and ventricular dilatation was clarified. For the first time within this cohort, not only severe disabling outcomes of hypoxic-ischemic encephalopathy, but also more subtle abnormalities of neurodevelopment, hearing, and quality of life in young children after therapeutic hypothermia were comprehensively characterized.
Practical significance. The obtained results substantiate the feasibility of using the Multiple Organ Dysfunction in Neonatal Encephalopathy score as an accessible tool for early integrated assessment of the severity of the post-asphyxial condition and for risk stratification of an adverse course of hypoxic-ischemic encephalopathy. The need to take ventricular dilatation into account as a basis for enhanced dynamic neurological monitoring, even in children without gross motor impairment, has been demonstrated. The importance of routine audiological screening and further hearing monitoring in children after therapeutic hypothermia has been confirmed. The feasibility of using the screening instruments Ages and Stages Questionnaires, Third Edition, and Infant and Toddler Quality of Life Questionnaire, 97-item version, at the age of 36–48 months has been demonstrated, as these are accessible methods for assessing neurodevelopment and quality of life under conditions of limited resources, war, and difficulties in conducting formal standardized tests.
