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Singh A, Saluja S, Kler N, Garg P, Soni A, Thakur A. Amplitude integrated EEG: how much it helps in prognostication in neonatal encephalopathy? J Matern Fetal Neonatal Med 2022; 35:7748-7755. [PMID: 34121586 DOI: 10.1080/14767058.2021.1937104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Neonatal encephalopathy (NE) is associated with a high risk of adverse neurological outcomes. Several neurodiagnostic tests have been evaluated to predict the prognosis. Amplitude integrated Electroencephalogram (aEEG) is now being commonly used for bedside evaluation of cerebral function. There is limited data on the role of aEEG for prognostication in NE, from resource-limited settings. OBJECTIVE To evaluate the predictive ability of aEEG for abnormal neurological outcomes in neonatal encephalopathy or neonates with encephalopathy. METHODS Neonates above 35 weeks of gestation admitted to NICU in a tertiary care hospital with a diagnosis of encephalopathy were enrolled. Clinical characteristics severity of encephalopathy and seizures were recorded. Amplitude integrated recording was started at admission and continued till recovery of trace to normal or for 10 days. The primary outcome was death or abnormal neurological status at 3-6 months of age. The study was registered in the Clinical Trial Registry of India (CTRI/2013/05/003612). RESULTS The incidence of NE was 6% of total admission. Moderate and severe encephalopathy occurred in 58 and 39% of babies respectively. Hypoxic-ischemic encephalopathy was the most common cause. Clinical seizures occurred in 91% of cases. An abnormal aEEG trace was observed in 51 (76.1%) infants with NE. For adverse neurological outcomes at an age average of 4.5 months of age, aEEG had a sensitivity, specificity, NPV, and PPV of 100, 54.2, 100, and 77.5, respectively. CONCLUSIONS Clinical staging and aEEG has good predictive ability to detect an adverse neurological outcome. aEEG improves the ability to predict abnormal outcome in babies with moderate encephalopathy. Early recovery of aEEG abnormality correlates with better neurodevelopmental outcomes.KEY MESSAGESWhat's known: aEEG is a useful modality to assess neurodevelopmental outcomes however data from developing countries is lacking.What's new: aEEG monitoring in babies in neonatal encephalopathy may improve the prediction of abnormal neurological outcomes in babies with moderate encephalopathy.
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Affiliation(s)
- Anita Singh
- Department of Neonatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | | | - Arun Soni
- Sir Ganga Ram Hospital, New Delhi, India
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Falsaperla R, Sciuto S, Gioè D, Sciuto L, Pisani F, Pavone P, Ruggieri M. Mild Hypoxic-Ischemic Encephalopathy: Can Neurophysiological Monitoring Predict Unfavorable Neurological Outcome? A Systematic Review and Meta-analysis. Am J Perinatol 2021; 40:833-838. [PMID: 34666398 DOI: 10.1055/s-0041-1736593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) is the second cause of neonatal deaths and one of the main conditions responsible for long-term neurological disability. Contrary to past belief, children with mild HIE can also experience long-term neurological sequelae. The aim of this systematic review is to determine the predictive value of long-term neurological outcome of (electroencephalogram) EEG/amplitude-integrated electroencephalogram (aEEG) in children who complained mild HIE. STUDY DESIGN From a first search on PubMed, Google Scholar, and clinicalTrials.gov databases, only five articles were considered suitable for this study review. A statistical meta-analysis with the evaluation of odds ratio was performed on three of these studies. RESULTS No correlation was found between the characteristics of the electrical activity of the brain obtained through EEG/aEEG in infants with mild HIE and subsequent neurological involvement. CONCLUSION EEG/aEEG monitoring in infants with mild HIE cannot be considered a useful tool in predicting their neurodevelopmental outcome, and its use for this purpose is reported as barely reliable. KEY POINTS · Hypoxic-Ischemic Encephalopathy is responsible for long-term neurological outcome, even in newborns with mild HIE.. · No correlation was found between EEG/aEEG trace in infants with mild HIE and neurological sequelae.. · Neurophysiological monitoring, in mild HIE, cannot predic neurodevelopmental outcome..
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Affiliation(s)
- Raffaele Falsaperla
- Division of Pediatrics and Pediatric Emergency, University Hospital Policlinico "Rodolico-San Marco," Catania, Italy.,Division of Neonatal Intensive Care and Neonatology, University Hospital Policlinico "Rodolico-San Marco," Catania, Italy
| | - Sarah Sciuto
- Division of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, Pediatrics Postgraduate Residency Program, University of Catania, Catania, Italy
| | - Daniela Gioè
- Division of Pediatrics, Hospital of Lentini, Lentini, Italy
| | - Laura Sciuto
- Division of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, Pediatrics Postgraduate Residency Program, University of Catania, Catania, Italy
| | - Francesco Pisani
- Division of Pediatrics, University Hospital of Children "Pietro Barilla," Parma, Italy
| | - Piero Pavone
- Division of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Martino Ruggieri
- Division of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
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Al Hajjar Y, Al Hajjar AESA, Daya B, Chauvet P. Intelligent Models to Predict the Prognosis of Premature Neonates According to Their EEG Signals. COGNITIVE ANALYTICS 2020:830-840. [DOI: 10.4018/978-1-7998-2460-2.ch043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The aim of this paper is to find the best intelligent model that allows predicting the future of premature newborns according to their electroencephalogram (EEG). EEG is a signal that measures the electrical activity of the brain. In this paper, the authors used a dataset of 397 EEG records detected at birth of premature newborns and their classification by doctors two years later: normal, sick or risky. They executed machine learning on this dataset using several intelligent models such as multiple linear regression, linear discriminant analysis, artificial neural network and decision tree. They used 14 parameters concerning characteristics extracted from EEG records that affect the prognosis of the newborn. Then, they presented a complete comparative study between these models in order to find who gives best results. Finally, they found that decision tree gave best result with performance of 100% for sick records, 76.9% for risky and 69.1% for normal ones.
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Han Y, Fu N, Chen W, Liang J, Cui Y, Zhang Y, Qin J. Prognostic Value of Electroencephalography in Hypothermia-Treated Neonates With Hypoxic-Ischemic Encephalopathy: A Meta-Analysis. Pediatr Neurol 2019; 93:3-10. [PMID: 30691779 DOI: 10.1016/j.pediatrneurol.2018.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/05/2018] [Accepted: 12/24/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Electroencephalography (EEG) background activity is associated with neurological outcome in neonates with hypoxic-ischemic encephalopathy. There is uncertainty about the prognostic value of EEG background activity after hypothermia was introduced. METHODS Searches were made on Pubmed, Embase, and the Cochrane Library, from inception to March 1, 2018. Pooled sensitivities and specificities were calculated to assess the diagnostic power of burst suppression, low voltage, and flat trace background activities in the prediction of an adverse neurological outcome in the follow-up period in hypothermia-treated neonates with hypoxic-ischemic encephalopathy. I2 was used to assess heterogeneity, and meta-regression was done to explore the source of heterogeneity. RESULTS Eighteen studies with 940 neonates were included. Pooled sensitivities and specificities in predicting the combination of death and neurodevelopmental impairment were burst suppression (sensitivity 0.87 [95% confidence interval (CI) 0.79 to 0.93], specificity 0.60 [95% CI 0.44 to 0.74]), low voltage (sensitivity 0.84 [0.75 to 0.90], specificity 0.80 [0.58 to 0.92]), and flat trace (sensitivity 0.85 [0.75 to 0.92], specificity 0.94 [0.77 to 0.99]). Subgroup analysis revealed the sensitivities of background patterns obtained after 24 hours of life were higher than those within age 24 hours, whereas the specificities were just the reverse. Flat trace performed best on sensitivity 0.93 (0.60 to 0.99) and specificity 0.90 (0.64 to 0.98) in predicting death. Burst suppression demonstrated the highest sensitivity 0.87 (0.58 to 0.97) and flat trace performed best on specificity 0.85 (0.60 to 0.96) in predicting neurodevelopmental impairment. CONCLUSIONS EEG background activity is predictive of long-term neurological outcome in hypothermia-treated neonates with hypoxic-ischemic encephalopathy. Burst suppression, low voltage, and flat trace are potential predictors of death or neurodevelopmental impairment.
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Affiliation(s)
- Ye Han
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Na Fu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Wenjie Chen
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Jingjing Liang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Yanan Cui
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Ying Zhang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China.
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Mahfooz N, Weinstock A, Afzal B, Noor M, Lowy DV, Farooq O, Finnegan SG, Lakshminrusimha S. Optimal Duration of Continuous Video-Electroencephalography in Term Infants With Hypoxic-Ischemic Encephalopathy and Therapeutic Hypothermia. J Child Neurol 2017; 32:522-527. [PMID: 28112011 DOI: 10.1177/0883073816689325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Continuous video-electroencephalography (EEG) is an important diagnostic and prognostic tool in newborns with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia. The optimal duration of continuous video-EEG during whole-body hypothermia is not known. We conducted a retrospective study of 35 neonates with hypoxic-ischemic encephalopathy undergoing whole-body hypothermia with continuous video-EEG. EEG ictal changes were detected in 9/35 infants (26%). Of these 9 infants, the seizures were initially observed within 30 minutes of EEG monitoring in 6 (67%), within 24 hours in 2 (22%), and during rewarming in 1 infant (11%). No new seizures were detected between 24-72 hours of therapeutic hypothermia. Background suppression was detected in 14 infants (40%) by 24 hours. In neonates with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia, continuous video-EEG has the highest diagnostic yield within the first 24 hours and during the rewarming phase. In the absence of prior seizures or antiepileptic therapy, limiting continuous video-EEG to these periods in resource-limited settings may reduce cost during therapeutic hypothermia.
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Affiliation(s)
- Naeem Mahfooz
- 1 Department of Neurology, Division of Pediatric Neurology, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA.,2 Neurological Institute, Epilepsy Center, Cleveland, OH, USA
| | - Arie Weinstock
- 1 Department of Neurology, Division of Pediatric Neurology, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - Bushra Afzal
- 3 Division of Neonatology, Department of Pediatrics, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mariam Noor
- 1 Department of Neurology, Division of Pediatric Neurology, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - David Vargas Lowy
- 3 Division of Neonatology, Department of Pediatrics, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - Osman Farooq
- 1 Department of Neurology, Division of Pediatric Neurology, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sarah G Finnegan
- 1 Department of Neurology, Division of Pediatric Neurology, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - Satyan Lakshminrusimha
- 3 Division of Neonatology, Department of Pediatrics, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
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Al Hajjar Y, Al Hajjar AESA, Daya B, Chauvet P. Intelligent Models to Predict the Prognosis of Premature Neonates According to Their EEG Signals. INTERNATIONAL JOURNAL OF BIOMEDICAL AND CLINICAL ENGINEERING 2017; 6:57-66. [DOI: 10.4018/ijbce.2017010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The aim of this paper is to find the best intelligent model that allows predicting the future of premature newborns according to their electroencephalogram (EEG). EEG is a signal that measures the electrical activity of the brain. In this paper, the authors used a dataset of 397 EEG records detected at birth of premature newborns and their classification by doctors two years later: normal, sick or risky. They executed machine learning on this dataset using several intelligent models such as multiple linear regression, linear discriminant analysis, artificial neural network and decision tree. They used 14 parameters concerning characteristics extracted from EEG records that affect the prognosis of the newborn. Then, they presented a complete comparative study between these models in order to find who gives best results. Finally, they found that decision tree gave best result with performance of 100% for sick records, 76.9% for risky and 69.1% for normal ones.
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Abstract
Hypoxic-ischemic encephalopathy is associated with a high risk of morbidity and mortality in the neonatal period. Long-term neurodevelopmental disability is also frequent in survivors. Conventional MRI defines typical patterns of injury that reflect specific pathophysiologic mechanisms. Advanced magnetic resonance techniques now provide unique perspectives on neonatal brain metabolism, microstructure, and connectivity. The application of these imaging techniques has revealed that brain injury commonly occurs at or near the time of birth and evolves over the first weeks of life. Amplitude-integrated electroencephalogram and near-infrared spectroscopy are increasingly used as bedside tools in neonatal intensive care units to monitor brain function.
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Affiliation(s)
- Stephanie L Merhar
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Perinatal Institute, ML 7009, Cincinnati, OH 45229, USA.
| | - Vann Chau
- Division of Neurology (Pediatrics), The Hospital for Sick Children, University of Toronto and Neuroscience & Mental Health Research Institute, 555 University Avenue, Room 6536B, Hill Wing, Toronto, Ontario M5G 1X8, Canada
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Awal MA, Lai MM, Azemi G, Boashash B, Colditz PB. EEG background features that predict outcome in term neonates with hypoxic ischaemic encephalopathy: A structured review. Clin Neurophysiol 2016; 127:285-296. [DOI: 10.1016/j.clinph.2015.05.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/28/2015] [Accepted: 05/12/2015] [Indexed: 01/22/2023]
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Hajjar YA, El Salam Al Hajjar A, Daya B, Chauvet P. Predication of premature neonates prognosis based on their electroencephalogram using artificial neural network. 2015 SAI INTELLIGENT SYSTEMS CONFERENCE (INTELLISYS) 2015. [DOI: 10.1109/intellisys.2015.7361190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Nanavati T, Seemaladinne N, Regier M, Yossuck P, Pergami P. Can We Predict Functional Outcome in Neonates with Hypoxic Ischemic Encephalopathy by the Combination of Neuroimaging and Electroencephalography? Pediatr Neonatol 2015; 56:307-16. [PMID: 25862075 PMCID: PMC4529385 DOI: 10.1016/j.pedneo.2014.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 12/04/2014] [Accepted: 12/25/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Neonatal hypoxic ischemic encephalopathy (HIE) is a major cause of mortality, morbidity, and long-term neurological deficits. Despite the availability of neuroimaging and neurophysiological testing, tools for accurate early diagnosis and prediction of developmental outcome are still lacking. The goal of this study was to determine if combined use of magnetic resonance imaging (MRI) and electroencephalography (EEG) findings could support outcome prediction. METHODS We retrospectively reviewed records of 17 HIE neonates, classified brain MRI and EEG findings based on severity, and assessed clinical outcome up to 48 months. We determined the relation between MRI/EEG findings and clinical outcome. RESULTS We demonstrated a significant relationship between MRI findings and clinical outcome (Fisher's exact test, p = 0.017). EEG provided no additional information about the outcome beyond that contained in the MRI score. The statistical model for outcome prediction based on random forests suggested that EEG readings at 24 hours and 72 hours could be important variables for outcome prediction, but this needs to be investigated further. CONCLUSION Caution should be used when discussing prognosis for neonates with mild-to-moderate HIE based on early MR imaging and EEG findings. A robust, quantitative marker of HIE severity that allows for accurate prediction of long-term outcome, particularly for mild-to-moderate cases, is still needed.
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Affiliation(s)
- Tania Nanavati
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Nirupama Seemaladinne
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Michael Regier
- Department of Biostatistics, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Panitan Yossuck
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Paola Pergami
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA.
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Temko A, Doyle O, Murray D, Lightbody G, Boylan G, Marnane W. Multimodal predictor of neurodevelopmental outcome in newborns with hypoxic-ischaemic encephalopathy. Comput Biol Med 2015; 63:169-77. [DOI: 10.1016/j.compbiomed.2015.05.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/22/2015] [Accepted: 05/23/2015] [Indexed: 11/28/2022]
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Del Balzo F, Maiolo S, Papoff P, Giannini L, Moretti C, Properzi E, Spalice A. Electroencephalogram and magnetic resonance imaging comparison as a predicting factor for neurodevelopmental outcome in hypoxic ischemic encephalopathy infant treated with hypothermia. Pediatr Rep 2014; 6:5532. [PMID: 25635216 PMCID: PMC4292060 DOI: 10.4081/pr.2014.5532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/08/2014] [Accepted: 08/11/2014] [Indexed: 11/23/2022] Open
Abstract
Hypoxic-ischemic encephalopathy (HIE) is an important cause of acute neurological damage in newborns at (or near) term. Several trials in recent years have shown that moderate hypothermia by total body cooling or selective head is an effective intervention to reduce mortality and major disability in infants survived a perinatal hypoxic-ischemic attack. Follow-up in these patients is very important to establish neurodevelopmental outcome, and specific markers can lead us to detect predicting sign for good or poor outcome. We reported a few cases of newborn with HIE treated with hypothermia, in whom the comparison between electroencephalogram (EEG) and magnetic resonance imaging (MRI) represents the first marker for neurodevelopment outcome prediction. The continuous EEG monitoring showed a depressed EEG activity with diffuse burst depression in 7 patients. No epileptic abnormalities were registered. In 10 out of 20 patients no abnormalities of the background activity and no epileptic abnormalities were observed. We found that a depressed EEG activity during the first 72 h of life and a diffused alteration of basal ganglia at MRI were correlated with a poor neurodevelopmental outcome at 18 months of follow-up.
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Affiliation(s)
- Francesca Del Balzo
- Division of Child Neurology, Department of Pediatrics, La Sapienza University , Rome, Italy
| | - Stella Maiolo
- Division of Child Neurology, Department of Pediatrics, La Sapienza University , Rome, Italy
| | - Paola Papoff
- Division of Child Neurology, Department of Pediatrics, La Sapienza University , Rome, Italy
| | - Luigi Giannini
- Division of Child Neurology, Department of Pediatrics, La Sapienza University , Rome, Italy
| | - Corrado Moretti
- Division of Child Neurology, Department of Pediatrics, La Sapienza University , Rome, Italy
| | - Enrico Properzi
- Division of Child Neurology, Department of Pediatrics, La Sapienza University , Rome, Italy
| | - Alberto Spalice
- Division of Child Neurology, Department of Pediatrics, La Sapienza University , Rome, Italy
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The electroencephalogram of the full-term newborn: Review of normal features and hypoxic-ischemic encephalopathy patterns. Neurophysiol Clin 2013; 43:267-87. [DOI: 10.1016/j.neucli.2013.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 11/21/2022] Open
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Jose A, Matthai J, Paul S. Correlation of EEG, CT, and MRI Brain with Neurological Outcome at 12 Months in Term Newborns with Hypoxic Ischemic Encephalopathy. J Clin Neonatol 2013; 2:125-30. [PMID: 24251256 PMCID: PMC3830147 DOI: 10.4103/2249-4847.119996] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To correlate electroencephalogram (EEG), computed tomography (CT), and magnetic resonance imaging (MRI) brain with neurological outcome at 12 months in term neonates with hypoxic ischemic encephalopathy. Design: Prospective observational study. Setting: Neonatal intensive care unit (NICU) in a tertiary care teaching hospital. Materials and Methods: The study was conducted between June 2010 and November 2011. Consecutive term neonates with perinatal asphyxia and hypoxic ischemic encephalopathy were the subjects. All babies were managed as per standard protocol. EEG was done as soon as the baby was stable and CT brain within 7 days. MRI was done at 3 months. Neurodevelpmental assessment was done at 12 months. Results: Of the 31 babies, four died and one was lost to follow-up. Neurodevelopmental at 12 months of age was normal in 15 babies. EEG was normal in six babies and all of them had a normal neurodevelopment. Thirteen of the 14 babies with burst suppression pattern were abnormal (P<0.001). CT brain was normal in 14 and all of them had normal neurodevelopment (P<0.001), while 11 of the 12 with cerebral edema had abnormal outcome (P<0.001). Of the 16 babies with normal MRI, 14 were normal, while all six babies with abnormal signals in the cortex and thalamus had abnormal outcome (P=0.002). Conclusions: A normal EEG and CT brain in a term newborn with hypoxic ischemic encephalopathy (HIE) is associated with good neurological outcome. Burst suppression pattern in EEG, bleeds, or hypodensities in the CT and involvement of basal ganglia/thalamus in the MRI are predictors of abnormal outcome.
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Affiliation(s)
- Annu Jose
- Department of Pediatrics, PSG Institute of Medical Sciences, Peelamedu, Coimbatore, Tamil Nadu, India
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Glass HC, Wusthoff CJ, Shellhaas RA. Amplitude-integrated electro-encephalography: the child neurologist's perspective. J Child Neurol 2013; 28:1342-50. [PMID: 23690296 PMCID: PMC4091988 DOI: 10.1177/0883073813488663] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neurologists increasingly recognize that critically ill patients are at high risk for seizures, particularly nonconvulsive seizures, and that neuromonitoring is a useful tool for diagnosing seizures and assessing brain function in these patients. Amplitude-integrated electroencephalography (EEG) is a simplified bedside neurophysiology tool that has become widely used in neonates over the past decade. Despite widespread interest by both neurologists and neonatologists in continuous brain monitoring, amplitude-integrated EEG has been largely ignored by neurologists, forcing neonatologists to "go it alone" when interpreting data from this bedside tool. Although amplitude-integrated EEG cannot replace conventional EEG for background monitoring and detection of seizures, it remains a useful instrument that complements conventional EEG, is being widely adopted by neonatologists, and should be supported by neonatal neurologists.
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Affiliation(s)
- Hannah C. Glass
- Departments of Neurology & Pediatrics, University of California, San Francisco
| | | | - Renée A. Shellhaas
- Department of Pediatrics & Communicable Diseases (Division of Pediatric Neurology), University of Michigan
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Abstract
OBJECTIVE To explore the association between multiple umbilical cord blood proteins and severity of hypoxic-ischemic encephalopathy as defined by continuous multichannel electroencephalography. DESIGN A prospective case-control cohort study, which was divided into separate exploratory and validation cohorts. SETTING A single tertiary neonatal intensive care facility. PATIENTS The study recruited full-term infants with perinatal asphyxia and controls. Identical procedures were used to recruit a representative exploratory sample (n = 30) and a subsequent validation cohort (n = 100). INTERVENTION All had umbilical cord blood drawn and biobanked at delivery, continuous multichannel electroencephalography commenced in the first 24 hours, and a modified Sarnat score assigned. Analysis of 37 potential cord blood protein markers of hypoxic-ischemic encephalopathy was performed using Luminex multiplex assays. MEASUREMENTS AND RESULTS Cord blood from 130 infants was analyzed. Interleukin-16 and interleukin-6 significantly differentiated between a moderate-severely abnormal and normal-mildly abnormal electroencephalography background in both exploratory (p = 0.005 and p = 0.016, respectively) and validation cohorts (p = 0.039 and p = 0.024, respectively). To develop a predictive model for a moderate-severely abnormal electroencephalography, stepwise regression analysis was used to combine these analytes with current standard clinical markers of asphyxia (pH, base deficit, and 10-min Apgar). Only Apgar score and interleukin-16 remained in the model, which was highly predictive of an abnormal electroencephalography (area under the curve [AUC] = 0.956, p < 0.001, positive predictive value = 89%, and negative predictive value = 94%). CONCLUSIONS Cord blood interleukin-6 and interleukin-16 were associated with electrographic grade of hypoxic-ischemic encephalopathy. To predict an abnormal electroencephalography, interleukin-16 and 10-minute Apgar used in combination performed better than current markers.
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Briatore E, Ferrari F, Pomero G, Boghi A, Gozzoli L, Micciolo R, Espa G, Gancia P, Calzolari S. EEG findings in cooled asphyxiated newborns and correlation with site and severity of brain damage. Brain Dev 2013; 35:420-6. [PMID: 22871392 DOI: 10.1016/j.braindev.2012.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/30/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE EEG and MRI are useful tools to evaluate the severity of brain damage and to provide prognostic indications in asphyxiated neonates. Aim of our study is to analyze the relationship between serial neonatal EEGs and severity and sites of brain lesions on MRI in neonates undergoing hypothermia, following a hypoxic-ischemic injury. PATIENTS AND METHODS Forty-eight term newborns underwent hypothermia. Serial videoEEG recordings were taken at 6, 24, 48 and 72 h and during 2nd week of life. Brain MRI was performed at the end of 2nd postnatal week and correlated with EEG. RESULTS EEGs improved during the first days. At the first recording 25 infants showed a severe or very low amplitude EEG pattern while at the 2nd week only 7 showed such patterns. As regards MRI, 21 infants showed a predominant Basal Ganglia and Thalami damage, 4 infants showed a predominant focal Thalami lesion and 23 showed normal imaging or just mild White Matter abnormalities. Severity of EEG pattern was associated with the odds of having MRI lesions at Basal Ganglia, Thalami, White Matter, Internal Capsule, but not at Cortex. Infants who showed only mild EEG abnormalities in the first 2 days had no Basal Ganglia and Thalami MRI lesion. The persistence of a discontinuous EEG at the 2nd week recording is always associated with Basal Ganglia and Thalami damage. CONCLUSION The severity of EEG background is associated with severity and site of MRI lesion pattern in neonates treated with hypothermia because of hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Eleonora Briatore
- Division of Child Neuropsychiatry, Santa Croce e Carle Hospital, Via Antonio Carle n°5, 12100 Cuneo, Italy.
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van Laerhoven H, de Haan TR, Offringa M, Post B, van der Lee JH. Prognostic tests in term neonates with hypoxic-ischemic encephalopathy: a systematic review. Pediatrics 2013; 131:88-98. [PMID: 23248219 DOI: 10.1542/peds.2012-1297] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) after perinatal asphyxia in term neonates causes long-term neurologic sequelae or death. A reliable evidence-based prognosis is essential. The study goal was to investigate the prognostic value of currently used clinical tests in neonatal patients with perinatal asphyxia and HIE. METHODS Searches were made on MEDLINE, Embase, Central, and CINAHL for studies occurring between January 1980 and November 2011. Studies were included if they (1) evaluated outcome in term infants with perinatal asphyxia and HIE, (2) evaluated prognostic tests, and (3) reported outcome at a minimal follow-up age of 18 months. Study selection, assessment of methodologic quality, and data extraction were performed by 3 independent reviewers. Pooled sensitivities and specificities of investigated tests were calculated when possible. RESULTS Of the 259 relevant studies, 29 were included describing 13 prognostic tests conducted 1631 times in 1306 term neonates. A considerable heterogeneity was noted in test performance, cut-off values, and outcome measures. The most promising tests were amplitude-integrated electroencephalography (sensitivity 0.93, [95% confidence interval 0.78-0.98]; specificity 0.90 [0.60-0.98]), EEG (sensitivity 0.92 [0.66-0.99]; specificity 0.83 [0.64-0.93]), and visual evoked potentials (sensitivity 0.90 [0.74-0.97]; specificity 0.92 [0.68-0.98]). In imaging, diffusion weighted MRI performed best on specificity (0.89 [0.62-0.98]) and T1/T2-weighted MRI performed best on sensitivity (0.98 [0.80-1.00]). Magnetic resonance spectroscopy demonstrated a sensitivity of 0.75 (0.26-0.96) with poor specificity (0.58 [0.23-0.87]). CONCLUSIONS This evidence suggests an important role for amplitude-integrated electroencephalography, EEG, visual evoked potentials, and diffusion weighted and conventional MRI. Given the heterogeneity in the tests' performance and outcomes studied, well-designed large prospective studies are needed.
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Affiliation(s)
- Henriette van Laerhoven
- Department of aNeonatology, Emma Children’s Hospital, Academic Medical Center Amsterdam, Netherlands
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19
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Walsh BH, Broadhurst DI, Mandal R, Wishart DS, Boylan GB, Kenny LC, Murray DM. The metabolomic profile of umbilical cord blood in neonatal hypoxic ischaemic encephalopathy. PLoS One 2012; 7:e50520. [PMID: 23227182 PMCID: PMC3515614 DOI: 10.1371/journal.pone.0050520] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 10/23/2012] [Indexed: 02/08/2023] Open
Abstract
Background Hypoxic ischaemic encephalopathy (HIE) in newborns can cause significant long-term neurological disability. The insult is a complex injury characterised by energy failure and disruption of cellular homeostasis, leading to mitochondrial damage. The importance of individual metabolic pathways, and their interaction in the disease process is not fully understood. The aim of this study was to describe and quantify the metabolomic profile of umbilical cord blood samples in a carefully defined population of full-term infants with HIE. Methods and Findings The injury severity was defined using both the modified Sarnat score and continuous multichannel electroencephalogram. Using these classification systems, our population was divided into those with confirmed HIE (n = 31), asphyxiated infants without encephalopathy (n = 40) and matched controls (n = 71). All had umbilical cord blood drawn and biobanked at −80°C within 3 hours of delivery. A combined direct injection and LC-MS/MS assay (AbsolutIDQ p180 kit, Biocrates Life Sciences AG, Innsbruck, Austria) was used for the metabolomic analyses of the samples. Targeted metabolomic analysis showed a significant alteration between study groups in 29 metabolites from 3 distinct classes (Amino Acids, Acylcarnitines, and Glycerophospholipids). 9 of these metabolites were only significantly altered between neonates with Hypoxic ischaemic encephalopathy and matched controls, while 14 were significantly altered in both study groups. Multivariate Discriminant Analysis models developed showed clear multifactorial metabolite associations with both asphyxia and HIE. A logistic regression model using 5 metabolites clearly delineates severity of asphyxia and classifies HIE infants with AUC = 0.92. These data describe wide-spread disruption to not only energy pathways, but also nitrogen and lipid metabolism in both asphyxia and HIE. Conclusion This study shows that a multi-platform targeted approach to metabolomic analyses using accurately phenotyped and meticulously biobanked samples provides insight into the pathogenesis of perinatal asphyxia. It highlights the potential for metabolomic technology to develop a diagnostic test for HIE.
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Affiliation(s)
- Brian H Walsh
- Neonatal Brain Research Group, Department of Paediatrics and Child Health, Cork University Maternity Hospital, Wilton, Cork, Ireland.
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20
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Korotchikova I, Stevenson N, Walsh B, Murray D, Boylan G. Quantitative EEG analysis in neonatal hypoxic ischaemic encephalopathy. Clin Neurophysiol 2011; 122:1671-8. [DOI: 10.1016/j.clinph.2010.12.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 12/17/2010] [Accepted: 12/18/2010] [Indexed: 10/18/2022]
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Takenouchi T, Rubens EO, Yap VL, Ross G, Engel M, Perlman JM. Delayed onset of sleep-wake cycling with favorable outcome in hypothermic-treated neonates with encephalopathy. J Pediatr 2011; 159:232-7. [PMID: 21353680 DOI: 10.1016/j.jpeds.2011.01.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 12/07/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine whether hypothermia modulates acquisition of sleep-wake cycling in term neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE) and the relationship to outcome. STUDY DESIGN Twenty-nine term infants with moderate to severe HIE treated with selective head cooling were evaluated. All were monitored with amplitude-integrated electroencephalography during and video electroencephalography immediately after hypothermia for ≥72 hours. Electroencephalograpic data were analyzed for background and sleep-wake cycling. Abnormal outcome included death or severe global neurodevelopmental disability ≥18 months. RESULTS Acquisition of sleep-wake cycling was noted in nine infants by 72 hours, in 13 by 96 hours, 19 by 120 hours, and 22 by 144 hours. Presence of sleep-wake cycling was associated with normal outcome, that is, 14 of 22 (64%), versus abnormal outcome, that is, none of seven without sleep-wake cycling (P = .006). The presence of sleep-wake cycling by 120 hours had a positive predictive value of 68% and negative predictive value of 90%. Magnetic resonance imaging abnormalities were related to onset of sleep-wake cycling. CONCLUSIONS Although onset of sleep-wake cycling is markedly delayed in term neonates with moderate to severe HIE treated with hypothermia, approximately 65% with acquisition of cycling have a normal outcome. Sleep-wake cycling is an important additional tool for assessing recovery in term infants with moderate to severe HIE treated with hypothermia.
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Affiliation(s)
- Toshiki Takenouchi
- Department of Pediatrics, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10021, USA
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22
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Walsh BH, Murray DM, Boylan GB. The use of conventional EEG for the assessment of hypoxic ischaemic encephalopathy in the newborn: a review. Clin Neurophysiol 2011; 122:1284-94. [PMID: 21550844 DOI: 10.1016/j.clinph.2011.03.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/14/2011] [Accepted: 03/30/2011] [Indexed: 02/06/2023]
Abstract
Neonatal hypoxic ischaemic encephalopathy continues to be one of the leading causes of morbidity and mortality among neonates around the globe. With the advent of therapeutic hypothermia, the need to accurately classify the severity of injury in the early neonatal period is of great importance. As clinical measures cannot always accurately estimate the severity early enough for treatment to be initiated, clinicians have become more dependent on conventional and amplitude integrated EEG. Despite this, there is currently no single agreed classification scheme for the neonatal EEG in hypoxic ischaemic encephalopathy. In this review we discuss classification schemes of neonatal background EEG, published over the past 35 years, highlighting the urgent need for a universal visual analysis scheme.
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Affiliation(s)
- B H Walsh
- Neonatal Brain Research Group, Cork University Maternity Hospital, Wilton, Cork, Ireland
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23
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Nash KB, Bonifacio SL, Glass HC, Sullivan JE, Barkovich AJ, Ferriero DM, Cilio MR. Video-EEG monitoring in newborns with hypoxic-ischemic encephalopathy treated with hypothermia. Neurology 2011; 76:556-62. [PMID: 21300971 DOI: 10.1212/wnl.0b013e31820af91a] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Therapeutic hypothermia (TH) is becoming standard of care in newborns with hypoxic-ischemic encephalopathy (HIE). The prognostic value of the EEG and the incidence of seizures during TH are uncertain. OBJECTIVE To describe evolution of EEG background and incidence of seizures during TH, and to identify EEG patterns predictive for MRI brain injury. METHODS A total of 41 newborns with HIE underwent TH. Continuous video-EEG was performed during hypothermia and rewarming. EEG background and seizures were reported in a standardized manner. Newborns underwent MRI after rewarming. Sensitivity and specificity of EEG background for moderate to severe MRI brain injury was assessed at 6-hour intervals during TH and rewarming. RESULTS EEG background improved in 49%, remained the same in 38%, and worsened in 13%. A normal EEG had a specificity of 100% upon initiation of monitoring and 93% at later time points. Burst suppression and extremely low voltage patterns held the greatest prognostic value only after 24 hours of monitoring, with a specificity of 81% at the beginning of cooling and 100% at later time points. A discontinuous pattern was not associated with adverse outcome in most patients (73%). Electrographic seizures occurred in 34% (14/41), and 10% (4/41) developed status epilepticus. Seizures had a clinical correlate in 57% (8/14) and were subclinical in 43% (6/14). CONCLUSIONS Continuous video-EEG monitoring in newborns with HIE undergoing TH provides prognostic information about early MRI outcome and accurately identifies electrographic seizures, nearly half of which are subclinical.
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Affiliation(s)
- K B Nash
- Department of Neurology, University of California, San Francisco, USA
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24
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Abstract
Neonatal electroencephalography (EEG) recordings have routinely been performed for more than half a century. ''Old'' technical difficulties are no longer of concern with the advent of modern digital technology. Still, many ''old'' issues are at debate: characterization of neonatal EEG features, identification of EEG waveforms with potential clinical correlates, the role of neonatal EEG in prediction of neurodevelopmental outcome, and use of new devices. In the past decades, neonatal EEG and emerging issues' literature has greatly expanded. In this review, the authors have summarized some of these issues to increase the availability of the information for both clinical and research purposes. They propose an up-to-date concentrated practical approach to this rapidly expanding ''subfield'' of neonatal neurology.
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Affiliation(s)
- Eilon Shany
- Department of Neonatology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel
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25
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Électroencéphalogramme du nouveau-né à terme. Aspects normaux et encéphalopathie hypoxo-ischémique. Neurophysiol Clin 2011; 41:1-18. [DOI: 10.1016/j.neucli.2010.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 11/26/2010] [Accepted: 12/12/2010] [Indexed: 11/22/2022] Open
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Hathi M, Sherman DL, Inder T, Rothman NS, Natarajan M, Niesen C, Korst LM, Pantano T, Natarajan A. Quantitative EEG in babies at risk for hypoxic ischemic encephalopathy after perinatal asphyxia. J Perinatol 2010; 30:122-6. [PMID: 19741652 DOI: 10.1038/jp.2009.130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate an electroencephalography (EEG)-based index, the Cerebral Health Index in babies (CHI/b), for identification of neonates with high Sarnat scores and abnormal EEG as markers of hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia. STUDY DESIGN This is a retrospective study using 30 min of EEG data collected from 20 term neonates with HIE and 20 neurologically normal neonates. The HIE diagnosis was made on clinical grounds based on history and examination findings. The maximum-modified clinical Sarnat score was used to grade HIE severity within 72 h of life. All neonates underwent 2-channel bedside EEG monitoring. A trained electroencephalographer blinded to clinical data visually classified each EEG as normal, mild or severely abnormal. The CHI/b was trained using data from Channel 1 and tested on Channel 2. RESULT The CHI/b distinguished among HIE and controls (P<0.02) and among the three visually interpreted EEG categories (P<0.0002). It showed a sensitivity of 82.4% and specificity of 100% in detecting high grades of neonatal encephalopathy (Sarnat 2 and 3), with an area under the receiver operator characteristic (ROC) curve of 0.912. CHI/b also identified differences between normal vs mildly abnormal (P<0.005), mild vs severely abnormal (P<0.01) and normal vs severe (P<0.002) EEG groups. An ROC curve analysis showed that the optimal ability of CHI/b to discriminate poor outcome was 89.7% (sensitivity: 87.5%; specificity: 82.4%). CONCLUSION The CHI/b identified neonates with high Sarnat scores and abnormal EEG. These results support its potential as an objective indicator of neurological injury in infants with HIE.
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Affiliation(s)
- M Hathi
- Infinite Biomedical Technologies, Baltimore, MD 21211, USA.
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27
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Murray DM, Boylan GB, Ryan CA, Connolly S. Early EEG findings in hypoxic-ischemic encephalopathy predict outcomes at 2 years. Pediatrics 2009; 124:e459-67. [PMID: 19706569 DOI: 10.1542/peds.2008-2190] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We examined the evolution of electroencephalographic (EEG) changes after hypoxic injury. METHODS Continuous, multichannel, video-EEG was recorded for term infants with hypoxic-ischemic encephalopathy, from <6 hours to 72 hours after delivery. One-hour segments at 6, 12, 24, and 48 hours of age of the EEG were analyzed visually, and neurologic outcome was assessed at 24 months. RESULTS Forty-four infants completed neurodevelopmental follow-up. Of those, 20 (45%) had abnormal outcomes. The EEG grade assigned correlated significantly with outcome. EEG abnormalities improved with time, with the worst EEG grade seen on the earliest recording in all cases. The best predictive ability was seen at 6 hours of age (area under the receiver operator characteristic curve: 0.958 [95% confidence interval: 0.88-1.04]; P = .000). Normal/mildly abnormal EEG results at 6, 12, or 24 hours had 100% positive predictive values for normal outcomes and negative predictive values of 67% to 76%. By 48 hours, many of the EEG findings had improved significantly. This led to the positive predictive value of abnormal EEG results being greater at 48 hours (93%), with a concurrent negative predictive value of 71%. EEG features that were associated with abnormal outcomes were background amplitude of <30 microV, interburst interval of >30 seconds, electrographic seizures, and absence of sleep-wake cycling at 48 hours. CONCLUSIONS Early EEG is a reliable predictor of outcome in HIE. A normal or mildly abnormal EEG results within 6 hours after birth were associated with normal neurodevelopmental outcomes at 24 months.
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Affiliation(s)
- Deirdre M Murray
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
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Mariani E, Scelsa B, Pogliani L, Introvini P, Lista G. Prognostic value of electroencephalograms in asphyxiated newborns treated with hypothermia. Pediatr Neurol 2008; 39:317-24. [PMID: 18940554 DOI: 10.1016/j.pediatrneurol.2008.07.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 07/23/2008] [Accepted: 07/28/2008] [Indexed: 11/16/2022]
Abstract
Previous studies described how early electroencephalogram patterns in neonatal hypoxic-ischemic encephalopathy seem to correlate with the severity of the clinical picture and provide prognostic information. This study evaluated whether electroencephalograms of newborns with severe perinatal hypoxic-ischemic encephalopathy, treated with hypothermia, provide information on clinical outcomes. Twenty-three newborns treated with hypothermia underwent electroencephalogram monitoring within 48 hours of age, and were enrolled in a follow-up with sequential electroencephalogram and neurologic controls (at ages 1 week, 1 month, 3-6 months, and 1 year). An inactive electroencephalogram pattern in the first 48 hours of age was associated with death or major neurologic sequelae. At age 1 week, a low-voltage, continuous pattern indicated a worse prognostic value when compared with other patterns. The persistence of electroencephalogram abnormalities at age 1 month was associated with a higher risk of neurologic sequelae. Background electroencephalogram abnormalities, detected in the first days of life after hypoxic-ischemic encephalopathy, can provide prognostic information, even in patients treated with hypothermia. After 1 month of age, the information on clinical outcomes provided by electroencephalograms usually decreases because of the natural trend toward electroencephalogram normalization.
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Affiliation(s)
- Emilio Mariani
- Unit of Clinical Neurophysiology, Instituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
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Shellhaas RA, Gallagher PR, Clancy RR. Assessment of neonatal electroencephalography (EEG) background by conventional and two amplitude-integrated EEG classification systems. J Pediatr 2008; 153:369-74. [PMID: 18534239 DOI: 10.1016/j.jpeds.2008.03.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 01/16/2008] [Accepted: 03/07/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the agreement among conventional electroencephalography (CEEG) terminology background classification and a simple and an advanced amplitude-integrated EEG (aEEG) system, and to evaluate whether aEEG interpreter experience or electrographic seizures affect this agreement. STUDY DESIGN CEEG background was classified by traditional interpretive criteria for 144 neonatal recordings, from which a single channel was converted to aEEGs. These aEEGs were independently interpreted by neonatologists according to the simple and advanced classification systems. RESULTS Interreader agreement was better with the simple aEEG system compared with the advanced aEEG system (multirater kappa, 0.66 vs 0.44). Fair-to-moderate agreement was found between both of the aEEG classification systems and CEEG (simple: kappa, 0.34 to 0.45; advanced: kappa, 0.36 to 0.45). Agreement did not vary significantly based on the aEEG interpreter experience or the presence of seizures. CONCLUSIONS Neonatologists found better agreement using the simple aEEG system regardless of their expertise or the presence of seizures. This finding has implications for patient selection in future multicenter neonatal neuroprotection studies.
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Affiliation(s)
- Renée A Shellhaas
- Division of Pediatric Neurology, Department of Pediatrics and Communicable Diseases, Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, MI, USA
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Martínez-Cruz CF, Poblano A, Fernández-Carrocera LA, Jiménez-Quiróz R, Tuyú-Torres N. Association between intelligence quotient scores and extremely low birth weight in school-age children. Arch Med Res 2006; 37:639-45. [PMID: 16740436 DOI: 10.1016/j.arcmed.2005.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 12/07/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Extremely low birth weight (ELBW) has been associated with poor cognitive development in children. We performed this research to establish the association between ELBW and the influence of biological and socioeconomic factors in the intelligence quotient (IQ) score in school-age children. METHODS This study comprised 184 children with mean and standard deviation of 6.9 +/- 0.8 years of age. The children were divided into four groups based on their birth weight as follows: group A (n = 25), < or =1000 g; group B (n = 52), 1001-1500 g; group C (n = 66), 1501-2500 g; and group D (n = 41), > or =2501 g. The Stanford-Binet after the Terman-Merril Intelligence Scale was used to determine IQ scores. RESULTS Mean and standard deviation (SD) of IQ values were 95.3 +/- 11.3 for group A, 103.1 +/- 14.4 for group B, 105.1 +/- 12.3 for group C, and 106.8 +/- 11.7 for group D (p = 0.003). Frequencies of children with scores below normal distribution were the following: 28% in group A; 10% in group B; 15% in group C, and 5% in group D (chi(2) = 0.04). Bronchopulmonary dysplasia and parental education were associated with lower IQ scores (p <0.05). CONCLUSIONS IQ scores of children born with ELBW were significantly lower when compared to children born with a higher birth weight. Additional studies are important to determine whether these neurodevelopmental delays persist into adulthood, and whether there are additional factors associated with catch-up and recovery.
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Murray DM, Ryan CA, Boylan GB, Fitzgerald AP, Connolly S. Prediction of seizures in asphyxiated neonates: correlation with continuous video-electroencephalographic monitoring. Pediatrics 2006; 118:41-6. [PMID: 16818547 DOI: 10.1542/peds.2005-1524] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND After perinatal asphyxia, predicting which infants will develop significant hypoxic-ischemic encephalopathy and neonatal seizures remains a difficult task. High-risk markers (Apgar score, acidosis, nucleated red blood cells, and resuscitation) have been used to predict neonatal seizures with varying success. The "3 strikes" of Apgar score of <5 at 5 minutes, pH <7.00, and need for intubation have been cited as having a positive predictive value of 80%. We examined whether the predictive values of these markers would be increased if early continuous electroencephalographic monitoring allowed us to accurately identify all neonatal seizures and to grade the encephalopathy. METHOD We recruited term infants with perinatal asphyxia. Continuous video electroencephalography was commenced soon after birth and continued for 24 to 72 hours. The abilities of high-risk markers to predict electroencephalographic seizures, background electroencephalographic activity, and Sarnat grade were examined. RESULTS Forty-nine infants were suitable for analysis. Electrographic seizures occurred in 11 of the 49 infants. Encephalopathy was scored by using Sarnat grade (6, severe; 18, moderate; 25, mild) and electroencephalographic findings (4 inactive, 4 major abnormalities, 16 moderate abnormalities, and 25 normal/mildly abnormal). Apgar score of <5 at 5 minutes, pH <7.0, and the need for intubation had positive predictive values for neonatal seizures of 18%, 16%, and 21%, respectively. Combining these markers gave a positive predictive value of 25% and a negative predictive value of 77%. Substituting base deficit or lactate for pH in the 3-strikes model did not improve its predictive value. Apgar score of <5 at 5 minutes, nucleated red blood cells, and a base deficit less than -15 mEq/L showed some association with Sarnat grade. Only 5-minute Apgar score was significantly associated with both Sarnat grade and electroencephalographic grade. CONCLUSION After perinatal asphyxia, neither the condition at birth nor the degree of metabolic acidosis reliably predict neonatal seizures.
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Affiliation(s)
- Deidre M Murray
- Department of Pediatrics and Child Health, University College Cork, Unified Maternity Services, Cork, Ireland
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Murray DM, Boylan GB, Ryan CA, Connolly S. Early continuous video-EEG in acute near-total intrauterine asphyxia. Pediatr Neurol 2006; 35:52-6. [PMID: 16814087 DOI: 10.1016/j.pediatrneurol.2006.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 09/01/2005] [Accepted: 01/03/2006] [Indexed: 11/22/2022]
Abstract
The evolution of electroencephalographic changes after acute hypoxic-ischemic injury is poorly understood, as a clear time of insult is often absent and continuous electroencephalographic monitoring in the first 3 days after such injury has not been previously reported. Infants who suffer sudden profound asphyxia, often termed "acute near-total intrauterine asphyxia", have evidence of damage to the deep gray matter. In these infants it is possible to time the onset and duration of cerebral ischemia. This report describes early continuous video-electroencephalography from 3 hours after birth in an infant with the characteristic clinical and radiologic features of acute near-total intrauterine asphyxia.
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Affiliation(s)
- Deirdre M Murray
- Department of Paediatrics and Child Health, University College Cork, Ireland
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Abstract
The pediatric neurologist's role in the neonatal intensive care unit is described in four clinical settings: (1) assessment of outcome in neonatal encephalopathy, (2) treatment of seizures in full-term infants, (3) assessment and treatment of intraventricular hemorrhage with posthemorrhagic hydrocephalus, and (4) assessment of outcome in preterm infants. Emphasis is placed on the evidenced-based information available in these settings and on new therapies on the horizon. Using evidence-based information, the pediatric neurologist can accurately assess prognosis in the neonatal period, and this can provide the basis for a rational assessment of newer therapies in neonatal intensive care.
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Affiliation(s)
- Walter C Allan
- Divisions of Pediatric Neurology and Neonatology, Department of Pediatrics, Barbara Bush Children's Hospital, Maine Medical Center, Portland, Maine, USA
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Abstract
The burst suppression pattern on the neonatal electroencephalogram (EEG) is associated with a poor outcome. However, this serious abnormality constitutes only a small proportion of discontinuous neonatal EEGs. We sought to establish whether any easily measurable parameters among the broad range of excessively discontinuous neonatal EEGs are predictive of outcome. We retrospectively reviewed the EEGs and medical records of 43 term infants with excessively discontinuous EEGs. We quantitated 10 parameters in the bursts and interburst intervals, among them the predominant interburst interval duration (defined as the duration of more than 50% of all interburst intervals of an EEG). Univariate and multivariate analyses were performed on the 10 EEG variables in relation to neurologic outcome and subsequent epilepsy. Based on multivariate analysis, a single easily measurable EEG parameter related significantly to outcome. A predominant interburst interval duration of more than 30 seconds correlated with the occurrence of both unfavorable neurologic outcome and subsequent epilepsy (P = 0.040 and P = 0.033, respectively). In conclusion, a infant whose EEG contains a predominant interburst interval duration of more than 30 seconds has a 100% probability of experiencing severe neurologic disabilities or death and an 86% chance of developing subsequent epilepsy. This easily quantitated EEG parameter could be valuable for the early estimation of neurologic prognosis.
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Affiliation(s)
- Caroline C Menache
- Department of Neurology; Children's Hospital; Harvard Medical School, Boston, Massachusetts 02115, USA
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35
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Pressler RM, Boylan GB, Morton M, Binnie CD, Rennie JM. Early serial EEG in hypoxic ischaemic encephalopathy. Clin Neurophysiol 2001; 112:31-7. [PMID: 11137658 DOI: 10.1016/s1388-2457(00)00517-4] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To perform early serial EEGs in infants with hypoxic ischaemic encephalopathy (HIE) and compare the findings with neurodevelopmental outcome. METHODS Nine full-term neonates with HIE had simultaneous video-EEG polygraphic studies within 8 h of birth. The EEG was repeated at 12-24 h intervals. All surviving infants had a neurodevelopmental assessment at 1 year. RESULTS Two infants had a normal or mildly abnormal EEG within 8 h of birth and neurodevelopmental outcome was normal. Seven infants had severely depressed background activity in the first 8 h of life. In 3 infants the EEG activity recovered within 12-24 h showing continuous activity with no or only minor abnormalities. All these infants had a normal outcome. The remaining 4 infants, who also had an initially inactive recording, subsequently developed severe background abnormalities. At follow-up, two infants had died and the remainder developed major neurological sequelae. CONCLUSIONS Early EEG is an excellent prognostic indicator for a favourable outcome if normal within the first 8 h of life and for a poor outcome if the background activity continues to be inactive or grossly abnormal beyond 8-12 h of life. However, an inactive or very depressed EEG within the first 8 h of life can be associated with good outcome if the EEG activity recovers within 12 h.
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Affiliation(s)
- R M Pressler
- Department of Clinical Neurophysiology, King's College Hospital, Denmark Hill, SE5 9RS, London, UK.
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Sweet DG, Bell AH, McClure G, Wallace IJ, Shields MD. Comparison between creatine kinase brain isoenzyme (CKBB) activity and Sarnat score for prediction of adverse outcome following perinatal asphyxia. J Perinat Med 2000; 27:478-83. [PMID: 10732307 DOI: 10.1515/jpm.1999.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To assess whether plasma creatine kinase brain isoenzyme (CKBB) levels or Sarnat scores are more accurate for prediction of poor neurological outcome in babies with suspected birth asphyxia. METHODS In a retrospective study of 97 babies CKBB levels were compared to the presence of severe hypoxic ischaemic encephalopathy (HIE) as a predictive test for these outcomes: developmental delay, cerebral palsy, visual problems, deafness or death from perinatal asphyxia. The tests were compared using positive predictive values (PPV) and likelihood ratios (LR) with confidence intervals (CI). RESULTS 3 babies had died from perinatal asphyxia and 14 survivors were found to have neurological or developmental problems. CKBB was elevated in babies with severe HIE (p = 0.0004). A receiver operator characteristic (ROC) curve showed the optimal discriminating value for CKBB to be 21 IU/L but the CKBB was a poor predictive test. For prediction of adverse outcome: CKBB > 21 sensitivity 76%, specificity 40%, PPV 21% and LR 1.3 (95% CI 0.8-1.7). Severe HIE sensitivity 53%, specificity 95%, PPV 69% and LR 10.6 (95% CI 3.8-29.2). CONCLUSION CKBB is elevated following birth asphyxia but is a poor predictor of adverse neurological outcome.
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Affiliation(s)
- D G Sweet
- Royal Maternity Hospital Neonatal Unit, Queen's University of Belfast, Northern Ireland.
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Abstract
The pediatric neurologist is often requested to predict the neurologic outcome in an uncertain situation. A common and problematic clinical setting in which this occurs is the asphyxiated term newborn. This report reviews the predictive tools available for prognostication in this situation and formulates a practical paradigm that the authors hope will improve predictive accuracy and lessen uncertainty in this setting.
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Affiliation(s)
- M I Shevell
- Department of Neurology/Neurosurgery, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Padula NA, Rugulo LM, Padovani CR, Teixeira A, Fonseca RG, Moura-Ribeiro MV, de Melo AN. [Video-polygraphic-EEG study in the full-term newborn with low birthweight for their gestational age]. ARQUIVOS DE NEURO-PSIQUIATRIA 1999; 57:571-9. [PMID: 10667279 DOI: 10.1590/s0004-282x1999000400006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Video-polygraphic-EEG studies were performed in the first 24 life-hours of 26 healthy full-term newborns without perinatal injuries. The neurological examination and cranial ultrasonography were normal. The newborns were divided into two groups: one, with full-term appropriate--birth weight 11 newborns (control group) and the other with full-term low-birth weight 15 newborns. Thirteen newborns of the second group had video-polygraphic-EEG study abnormalities. The most frequent abnormalities were found in 11 cases, as far as sleep architecture is concerned. Also, when compared with the control group, 8 cases of an excessive amount of startles and 2 cases of low behavior activities were found. The results demonstrate the usefulness of video-polygraphic-EEG study in the full-term newborns with intra-uterine growth retard. This examination was sensitive to detect behavior, sleep architecture and EEG standard differences in the low birth-weight newborns as to the control group.
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Affiliation(s)
- N A Padula
- Hospital das Clínicas da Faculdade de Medicina (FM) de Botucatu da Universidade Estadual de São Paulo (UNESP), Brasil.
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al Naqeeb N, Edwards AD, Cowan FM, Azzopardi D. Assessment of neonatal encephalopathy by amplitude-integrated electroencephalography. Pediatrics 1999; 103:1263-71. [PMID: 10353940 DOI: 10.1542/peds.103.6.1263] [Citation(s) in RCA: 300] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To define normal and abnormal patterns, test interobserver variability, and the prognostic accuracy of amplitude-integrated electroencephalography (aEEG) soon after the onset of neonatal encephalopathy. METHODS Consecutive cases of neonatal encephalopathy (n = 56; gestation median, 40; range, 35-42 weeks) and healthy infants (n = 14; gestation median, 40; range, 39-40 weeks) were studied. aEEG was recorded using a cerebral function monitor, at median, 0, range, 0-21 days of age. Of the infants, 24 of the 56 with encephalopathy and all of the normal infants were studied within 12 hours of birth (median, 5; range, 3-12 hours). Forty infants were suspected of having suffered birth asphyxia. Criteria for normal and abnormal patterns were defined and the interobserver variability of these classifications determined. Results were compared with neurodevelopmental outcome assessed at 18 to 24 months of age. aEEG also was compared with a standard EEG and with magnetic resonance imaging. RESULTS The median upper margin of the widest band of aEEG activity in the control infants was 37.5 microV (range, 30-48 microV), and median lower margin was 8 microV (range, 6.5-11 microV). We classified the aEEG background activity as normal amplitude, the upper margin of band of aEEG activity >10 microV and the lower margin >5 microV; moderately abnormal amplitude, the upper margin of band of aEEG activity >10 microV and the lower margin </=5 microV; and suppressed amplitude, the upper margin of the band of aEEG activity <10 microV and lower margin <5 microV. Recordings were analyzed further for the presence of seizures, defined as periods of sudden increase in voltage accompanied by a narrowing of the band of aEEG activity. Tests of interobserver variability showed excellent agreement both for assessment of amplitude (kappa statistic = 0.85) and for identification of seizures (kappa statistic = 0.76) There was a close relationship between the aEEG and subsequent outcome: 19 of 21 infants with a normal aEEG finding were normal on follow-up at 18 to 24 months of age, whereas 27 of 35 infants with a moderately abnormal or suppressed aEEG and/or seizures died or developed neurologic abnormalities. Thus, aEEG predicted outcome with a sensitivity of 0. 93, a specificity of 0.70, positive predictive value of 0.77, negative predictive value of 0.90, and the likelihood ratio of a positive result of 3.1 and a negative result of 0.06. For the 24 infants studied within 12 hours of birth, the corresponding results were sensitivity, 1.0; specificity, 0.82; positive predictive value, 0.85; negative predictive value, 1; likelihood ratio of a positive result, 5.5; and likelihood ratio of a negative result, 0.18. CONCLUSION The aEEG is a simple but accurate and reproducible clinical tool that could be useful in the assessment of infants with encephalopathy.
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Affiliation(s)
- N al Naqeeb
- Department of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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Casalaz DM, Marlow N, Speidel BD. Outcome of resuscitation following unexpected apparent stillbirth. Arch Dis Child Fetal Neonatal Ed 1998; 78:F112-5. [PMID: 9577280 PMCID: PMC1720775 DOI: 10.1136/fn.78.2.f112] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There are few data to inform a decision to resuscitate babies who are unexpectedly stillborn. The outcome for 42 successfully resuscitated stillborn children, of whom 62% survived to be discharged home, is reported. Of the survivors, a poor outcome with severe disability was found in 23% (including one postneonatal death), equivocal outcome was found in 15% (two mild hypertonia; two with mild hemiplegia and no associated other disability) and 62% were free of any impairment at follow up 20 months to 8 years later. In 39 (93%) fetal problems had been identified and the resuscitation team was present at delivery. Poor outcome was associated with late return of heart beat, delayed respirations, neonatal acidaemia and early onset of seizures. Of the unexpected apparent stillbirths successfully resuscitated, 52% died or survived severely disabled, 10% had an equivocal outcome, but 36% survived apparently intact. Therefore, vigorous resuscitation is clearly indicated in these circumstances.
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Affiliation(s)
- D M Casalaz
- Department of Child Health, University of Bristol, St Michael's Hospital
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Scalais E, François-Adant A, Nuttin C, Bachy A, Guérit JM. Multimodality evoked potentials as a prognostic tool in term asphyxiated newborns. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1998; 108:199-207. [PMID: 9566633 DOI: 10.1016/s0168-5597(97)00076-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hypoxic-ischemic (HI) events may cause permanent brain damage, and it is difficult to predict the long-term neurological outcome of survivors. Multimodality evoked potentials (MEPs), using flash visual (fVEPs), somatosensory (SEPs), and brain-stem auditory evoked potentials (BAEPs) may assess the cerebral function in term neonates. MEPs were recorded in 40 hypoxic-ischemic term or near-term neonates during the first week of life in order to predict the neurological outcome. A 3 point grading system registered either mild, moderate, or severe abnormalities. At 24 months of corrected age, the infants were assessed with a blind protocol to determine neurological development. Grade 0 fVEPs and SEPs were associated with a normal neurological status with 100% (P < 0.001) of the infants. Abnormal SEPs or total grade (VEPs + SEPs) > I were not associated with normal outcomes (P < 0.0001). Normal BAEPs did not predict a normal outcome, but severely abnormal BAEPs did predict an abnormal outcome. A significant correlation was found between EP (VEPs + SEPs) grade (r = 0.9, P < 0.0001), Sarnat stage (r = 0.6, P < 0.001), and clinical outcome. This study confirmed that both fVEPs and SEPs are more accurate as prognostic indicators for term neonates. EPs (VEPs + SEPs) also are more accurate in predicting the ultimate neurological outcome compared with the Sarnat scoring.
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Affiliation(s)
- E Scalais
- Department of Pediatrics, Pediatric Neurology, Entité Hospitalière, Centre Hospitalier Espérance St-Joseph, Liège, Belgium
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