Early clinical signs in neonates with hypoxic ischemic encephalopathy predict an abnormal amplitude-integrated electroencephalogram at age 6 hours

Horn, A; Swingler, George; Myer, Landon; Linley, L L; Raban, Moegammad Shukri; Joolay, Yaseen; Harrison, Michael; Chandrasekaran, M; Rhoda, Natasha; Robertson, Nicola J.

doi:10.1186/1471-2431-13-52

Cited by 52 publications

(53 citation statements)

References 29 publications

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“…Perinatal HIE involves two distinct phases: Immediate primary neuronal death associated with cellular hypoxia and depletion of energy stores; and a secondary phase of delayed neuronal death (at approximately 6 h) associated with reperfusion injury (17). Establishing correct judgment and treatment is critical for the prognosis of newborns with HIE before 6 h of life (18). Overall, the present study established a correction formula for NSE in serum obtained from newborns within 24 h of birth.…”

Section: Discussionmentioning

confidence: 99%

A correction formula for neuron‑specific enolase measurement in hemolyzed neonatal serum samples

Wang

Guang-rong

et al. 2018

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Abstract. As a specific biomarker in neonatal hypoxic-ischemic encephalopathy (HIE), the measurement of neuron-specific enolase (NSE) has been advocated as a predictor of outcome in neurological injury. However, the measured levels of NSE may be influenced by hemolysis. In the current study, the change in the concentration of NSE in serum was measured by chemiluminescence prior to and following the addition of individual frozen and thawed red blood cells from 86 neonates that were collected within 24 h of birth. The changes in the concentration of NSE were compared with the changes in the concentration of hemoglobin (Hb), measured by the hemoglobin cyanide (HiCN) method, to establish a correction formula. The performance of the correction formula was evaluated by comparing the corrected concentration of NSE using the individual constants and the correction formula. The average individual constant of NSE from the 86 hemolyzed neonatal serum samples was 25.15±3.94 mg/g Hb. The concentration variation between NSE and Hb in neonatal sera could be described by the equation ΔNSE serum =1.8594+24.0670 xΔHb HiCN (r²= 0.8045, P<0.001). There was no statistically significant difference in the NSE corrected results between the individual constant group and the correction formula group (Z=-1.645, P=0.100). The linear regression formula of Hb measured with the instrumental method compared with the HiCN method was Hb instr = 0.9816xHb HiCN +0.5596 (r²= 0.9924, P<0.001). Based on these regression analyses, the correction formula for NSE in hemolyzed neonatal serum was determined as NSE corr =NSE meas -24.0670xHb HiCN -1.8594 or NSE corr = NSE meas -24.5181xHb instr +11.8609. In conclusion, hemolysis has a substantial influence on the accurate measurement of NSE in neonatal serum samples. For hemolyzed neonatal serum samples, correcting the NSE results using a correction formula is essential to evaluate the severity of neonatal hypoxic ischemic encephalopathy. IntroductionHypoxic-ischemic encephalopathy (HIE) secondary to perinatal asphyxia remains a major cause of neonatal mortality and morbidity worldwide (1,2). The incidence of HIE ranges from 1 to 3 per 1,000 full-term infants and is present in almost 60% of premature newborns (3-5). Approximately 15-20% of affected newborns succumb within the postnatal period, and an additional 25% develop severe and permanent neuropsychological handicaps, including cerebral palsy, seizures, visual impairment, mental retardation, learning disabilities and epilepsy (5).Neuron-specific enolase (NSE) belongs to the family of enolase enzymes present in all tissues and organisms capable of glycolysis (6). Enolases consist of three subunits (α, β, and γ) encoded by separate genes. These subunits may combine to form five different isoenzymes: αα, αβ, αγ, ββ and γγ (6). NSE, comprised of γγ homodimers and αγ heterodimers, is widely distributed in central nervous system neurons and amine precursor uptake and decarboxylation cells (7). As a marker of neuronal cell death, the serum concentration of N...

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Section: Discussionmentioning

confidence: 99%

A correction formula for neuron‑specific enolase measurement in hemolyzed neonatal serum samples

Wang

Guang-rong

et al. 2018

biom rep

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“…If moderate or severe defect or seizure was found on encephalogram, the baby was included in the study. aEEG was considered severely defective in presence of continuous low voltage, burst suppression and flat tracing on the background design of the encephalogram and it was considered moderately defective in presence of discontinuous normal voltage (18)(19)(20)(21). Since there was only one aEEG device in the unit, the device was put on another patient who needed EEG only after an at least 30-minute recording was made.…”

Section: Methodsmentioning

confidence: 99%

Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: Short term results

Atıcı¹,

Çelik²,

Gülaşı³

et al. 2015

Turk Arch Ped

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Aim: In this study, it was aimed to investigate which method was superior by applying selective head cooling or whole body cooling therapy in newborns diagnosed with moderate or severe hypoxic ischemic encephalopathy. Material and Methods: Newborns above the 35th gestational age diagnosed with moderate or severe hypoxic ischemic encephalopathy were included in the study and selective head cooling or whole body cooling therapy was performed randomly. The newborns who were treated by both methods were compared in terms of adverse effects in the early stage and in terms of short-term results. Ethics committee approval was obtained for the study (06.01.2010/35). Results: Fifty three babies diagnosed with hypoxic ischemic encephalopathy were studied. Selective head cooling was applied to 17 babies and whole body cooling was applied to 12 babies. There was no significant difference in terms of adverse effects related to cooling therapy between the two groups. When the short-term results were examined, it was found that the hospitalization time was 34 (7-65) days in the selective head cooling group and 18 (7-57) days in the whole body cooling group and there was no significant difference between the two groups (p=0.097). Four patients in the selective head cooling group and two patients in the whole body cooling group were discharged with tracheostomy because of the need for prolonged mechanical ventilation and there was no difference between the groups in terms of discharge with tracheostomy (p=0.528). Five patients in the selective head cooling group and three patients in the whole body cooling group were discharged with a gastrostomy tube because they could not be fed orally and there was no difference between the groups in terms of discharge with a gastrostomy tube (p=0.586). One patient who was applied selective head cooling and one patient who was applied whole body cooling died during hospitalization and there was no difference between the groups in terms of mortality (p=0.665). Conclusions: There is no difference between the methods of selective head cooling and whole body cooling in terms of adverse effects and short-term results. (Türk Ped Arş 2015; 50: 27-36)

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“…The Thompson score is a numeric scoring system that requires no equipment and no specific training with a high predictive value for outcome [17]. Recently, Thompson scores were analyzed during or just before the start of hypothermia [18,19,20]. The primary aim of the present study was to compare Thompson scores and aEEG patterns in infants selected for therapeutic hypothermia, and relate these findings to outcome at 2 years of age.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of the Thompson Encephalopathy Score and Amplitude-Integrated Electroencephalography in Infants with Perinatal Asphyxia and Therapeutic Hypothermia

et al. 2017

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Background: In previous studies clinical signs or amplitude-integrated electroencephalography (aEEG)-based signs of encephalopathy were used to select infants with perinatal asphyxia for treatment with hypothermia. Aim: The objective of this study was to compare Thompson encephalopathy scores and aEEG, and relate both to outcome. Subjects and Methods: Thompson scores, aEEG, and outcome were compared in 122 infants with perinatal asphyxia and therapeutic hypothermia. Of these 122 infants, 41 died and 7 had an adverse neurodevelopmental outcome. A receiver operating characteristics (ROC) analysis was also performed. Results: Thompson scores were higher in infants with more abnormal aEEG background patterns (ANOVA, p < 0.001). The ROC analysis demonstrated that a Thompson score of 11 or higher or an aEEG background pattern of continuous low voltage or worse was associated with an adverse outcome (AUC 0.84 for both). Conclusions: High Thompson scores and a suppressed aEEG background pattern are associated with an adverse outcome after perinatal asphyxia and therapeutic hypothermia. Further studies are needed to identify the best technique with which to select patients for therapeutic hypothermia

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Early clinical signs in neonates with hypoxic ischemic encephalopathy predict an abnormal amplitude-integrated electroencephalogram at age 6 hours

Cited by 52 publications

References 29 publications

A correction formula for neuron‑specific enolase measurement in hemolyzed neonatal serum samples

A correction formula for neuron‑specific enolase measurement in hemolyzed neonatal serum samples

Comparison of selective head cooling therapy and whole body cooling therapy in newborns with hypoxic ischemic encephalopathy: Short term results

A Comparison of the Thompson Encephalopathy Score and Amplitude-Integrated Electroencephalography in Infants with Perinatal Asphyxia and Therapeutic Hypothermia

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