Can We Predict Functional Outcome in Neonates with Hypoxic Ischemic Encephalopathy by the Combination of Neuroimaging and Electroencephalography?

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.

Optimizing Cerebral Autoregulation May Decrease Neonatal Regional Hypoxic-Ischemic Brain Injury

“…[26, 27] We used T1/T2-weighted images, trace of diffusion images, and ADC maps given the high specificity and sensitivity of these sequences in predicting neurodevelopmental outcomes. [28] In addition, qualitatively scoring brain injury on MRI during the first two weeks of life and after therapeutic hypothermia has consistent and high predictive accuracy for neurodevelopmental outcome.…”

Use of near-infrared spectroscopy (NIRS) in cerebral tissue oxygenation monitoring in neonates

“…MRI can predict outcome reliably only in severe HIE cases. Early EEG findings (24 h) do not provide additional support for outcome prediction and are nonspecific, possibly in relation to medication use 38 . cStO 2 was significantly higher between 24 and 48 weeks of age in neonates with HIE with adverse outcomes as compared to those with favourable outcomes, suggesting a decrease in cerebral oxygen consumption during secondary energy failure.…”

“…Neonatal HIE (hypoxic-ischemic encephalopathy) is a major cause of mortality, morbidity, and long-term neurological deficits 38 . Despite the progress in diagnostic modalities, accurate prediction of outcome in neonates with HIE remains a great challenge.…”

Recent Information on the Pathogenesis and Treatment of Hypoxic-Ischemic Brain Lesions in Newborns

“…Авторы работы подчеркивают, что исследования отличались большой методологической гетерогенностью, в связи с чем имеется необходимость в организации новых круп-ных проспективных исследований. В подтверждение это-му недавно выполненный и потому не вошедший в при-веденный метаанализ анализ исходов ГИПП центральной нервной системы в одном из университетов США показал ПЕДИАТРИЧЕСКАЯ ФАРМАКОЛОГИЯ /2016/ ТОМ 13/ № 5 связь тяжести исходов с МРТ-данными (МРТ проводилась в течение недели после рождения) и отсутствие связи с ЭЭГ-параметрами [76]. Однако, это исследование про-водилось на небольшой когорте (n = 17), ретроспективно, что ограничивало ЭЭГ-анализ и оценку развития исходов.…”