Cooling and seizure burden in term neonates: an observational study

Low, Evonne; Boylan, Geraldine B.; Mathieson, Sean; Murray, Deirdre M.; Korotchikova, Irina; Stevenson, Nathan J.; Livingstone, Vicki; Rennie, Janet M.

doi:10.1136/archdischild-2011-300716

Cited by 127 publications

(113 citation statements)

References 33 publications

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“…High levels of agreement, comparable to our study, were reported for the detection of adult seizures,14 as well as for short duration recordings from a small cohort of seven neonates with seizures 11. In contrast, a recent study on older, acutely ill children with seizures reported a much lower kappa of 0.47,17 and another study in short duration recordings from 20 neonates reported an averaged ICC (equivalent to kappa for a binary outcome) of 0.57 10. A key difference in study methods is the length of EEG recording used.…”

Section: Discussionsupporting

confidence: 87%

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Interobserver agreement for neonatal seizure detection using multichannel EEG

Stevenson

Clancy

Vanhatalo

et al. 2015

Ann Clin Transl Neurol

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ObjectiveTo determine the interobserver agreement (IOA) of neonatal seizure detection using the gold standard of conventional, multichannel EEG.MethodsA cohort of full‐term neonates at risk of acute encephalopathy was included in this prospective study. The EEG recordings of these neonates were independently reviewed for seizures by three international experts. The IOA was estimated using statistical measures including Fleiss' kappa and percentage agreement assessed over seizure events (event basis) and seizure duration (temporal basis).ResultsA total of 4066 h of EEG recordings from 70 neonates were reviewed with an average of 2555 seizures detected. The IOA was high with temporal assessment resulting in a kappa of 0.827 (95% CI: 0.769–0.865; n = 70). The median agreement was 83.0% (interquartile range [IQR]: 76.6–89.5%; n = 33) for seizure and 99.7% (IQR: 98.9–99.8%; n = 70) for nonseizure EEG. Analysis of events showed a median agreement of 83.0% (IQR: 72.9–86.6%; n = 33) for seizures with 0.018 disagreements per hour (IQR: 0.000–0.090 per hour; n = 70). Observers were more likely to disagree when a seizure was less than 30 sec. Overall, 33 neonates were diagnosed with seizures and 28 neonates were not, by all three observers. Of the remaining nine neonates with contradictory EEG detections, seven presented with low total seizure burden.InterpretationThe IOA is high among experts for the detection of neonatal seizures using conventional, multichannel EEG. Agreement is reduced when seizures are rare or have short duration. These findings support EEG‐based decision making in the neonatal intensive care unit, inform EEG interpretation guidelines, and provide benchmarks for seizure detection algorithms.

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Section: Discussionsupporting

confidence: 87%

“…Each group was dichotomized with a threshold of: (1) 5 min per hour; (2) 12 min per hour; and (3) 30 min per hour. The first is potentially a minimum burden to initiate treatment with ASDs, the second may be useful for prognosis and the third is a common definition of electrographic status epilepticus 15, 16, 17…”

Section: Methodsmentioning

confidence: 99%

Interobserver agreement for neonatal seizure detection using multichannel EEG

Stevenson

Clancy

Vanhatalo

et al. 2015

Ann Clin Transl Neurol

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“…A similar number of neonates from our hypothermic and normothermic cohorts were treated with AEDs, but neonates treated with therapeutic hypothermia more frequently received one AED, while neonates not treated therapeutic hypothermia received three or more AEDs. This most probably reflects the increased seizure burden in the non‐therapeutic hypothermia group 10. The potential effects of AEDs on seizure burden and EEG background were not analysed in our cohort.…”

Section: Discussionmentioning

confidence: 95%

“…However, current protocols for therapeutic hypothermia are more effective in moderate than severe encephalopathy,1 and the TSB is significantly reduced in neonates undergoing therapeutic hypothermia with clinically moderate but not severe HIE 10. In HIE cohorts with hypothermia, seizures on cEEG were associated with more severe structural brain damage, although 40% of neonates with seizures may have a normal MRI 13, 14…”

Section: Discussionmentioning

confidence: 99%

Seizure burden and neurodevelopmental outcome in neonates with hypoxic–ischemic encephalopathy

Kharoshankaya

Stevenson

Livingstone

et al. 2016

Develop Med Child Neuro

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AimTo examine the relationship between electrographic seizures and long‐term outcome in neonates with hypoxic–ischemic encephalopathy (HIE).MethodFull‐term neonates with HIE born in Cork University Maternity Hospital from 2003 to 2006 (pre‐hypothermia era) and 2009 to 2012 (hypothermia era) were included in this observational study. All had early continuous electroencephalography monitoring. All electrographic seizures were annotated. The total seizure burden and hourly seizure burden were calculated. Outcome (normal/abnormal) was assessed at 24 to 48 months in surviving neonates using either the Bayley Scales of Infant and Toddler Development, Third Edition or the Griffiths Mental Development Scales; a diagnosis of cerebral palsy or epilepsy was also considered an abnormal outcome.ResultsContinuous electroencephalography was recorded for a median of 57.1 hours (interquartile range 33.5–80.5h) in 47 neonates (31 males, 16 females); 29 out of 47 (62%) had electrographic seizures and 25 out of 47 (53%) had an abnormal outcome. The presence of seizures per se was not associated with abnormal outcome (p=0.126); however, the odds of an abnormal outcome increased over ninefold (odds ratio [OR] 9.56; 95% confidence interval [95% CI] 2.43–37.67) if a neonate had a total seizure burden of more than 40 minutes (p=0.001), and eightfold (OR: 8.00; 95% CI: 2.06–31.07) if a neonate had a maximum hourly seizure burden of more than 13 minutes per hour (p=0.003). Controlling for electrographic HIE grade or treatment with hypothermia did not change the direction of the relationship between seizure burden and outcome.InterpretationIn HIE, a high electrographic seizure burden is significantly associated with abnormal outcome, independent of HIE severity or treatment with hypothermia.

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“…In an RCT with a similar design and effect size (placebo control, first line, rSB 1 , T d = 1h in Table 1); our model would have predicted a sample size of 14 neonates per group. Low et al (2012) also showed a significant reduction in total seizure burden in neonates treated with hypothermia in a cohort of 31 neonates [19]. In this case, our model would predict a cohort of 40 neonates based on a similar effect size; equivalent to an AED effect of 100% for 72h given within 1h of seizure onset (see placebo control, first line, TSB in Table 2).…”

Section: Aed Protocolmentioning

confidence: 99%