Early phosphate tracked mortality in cooled encephalopathy; validation is still missing
In 441 cooled term and near-term infants, phosphate around 6 hours was higher among non-survivors and showed an AUC of 0.90 for in-hospital mortality. The cutoff remains hypothesis-generating: it came from one retrospective cohort, phosphate was available in 394 infants, and the endpoint included redirection-of-care deaths.
THE HOT TAKE
A routine early phosphate result may be a severity signal. A single-center cutoff is not yet a prognostic instrument.
A retrospective cohort of 441 infants with moderate-to-severe neonatal encephalopathy found a striking separation at the first routine chemistry panel. Median phosphate was 1.8 mmol/L (IQR 1.6-2.2) among survivors and 3.3 mmol/L (IQR 2.7-4.1) among non-survivors; phosphate results were available for 394 infants. Fifty-five infants died in hospital, a mortality rate of 12.5%.
| Analysis | Reported estimate | Boundary |
|---|---|---|
| Observed phosphate | Survivors 1.8 [1.6-2.2] vs non-survivors 3.3 [2.7-4.1] mmol/L | 394 phosphate values available |
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