Electroencephalography and brain magnetic resonance imaging in asphyxia comparing cooled and non-cooled infants

Abstract

The aim was to establish any differences in the predictive value of EEG and MRI for outcome in infants treated and not-treated with therapeutic hypothermia (HT) for perinatal asphyxia. We hypothesize that they are equally predictive and that combining both has the highest predictive value. Study design: We retrospectively compared data of infants with hypoxic-ischemic encephalopathy (HIE) who received HT (n ¼ 45) between September 2009 and December 2013 with those of infants with HIE born between January 2004 and August 2009, before HT was available (NT, n ¼ 37). All received conventional and/or amplitudeeintegrated EEG during the first days and early MRI (day 4e5). Associations of EEG, MRI and severe neurodevelopmental outcome (death or Bayley's -2SD below mean), were tested with a multivariable logistic regression analysis, corrected for HT. Results: Forty-eight hours' EEG background pattern had a PPV of 92% and a NPV of 81% in HT, versus 100% and 58% in NT. MRI had a PPV of 71% and a NPV of 93% in HT, versus 82%

Predictors of Long-Term Neurodevelopmental Outcome of Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia

“…71 An abnormal EEG background (burst suppression, low voltage, or flat trace) at 48 hours in cooled infants had a positive predictive value (PPV) of 92% and a negative predictive value (NPV) of 81% for adverse outcome at 2 years, while normalization of the EEG background by 48 hours decreases the odds for adverse outcome (odds ratio [OR]: 0.013), regardless of cooling and adjusted for evidence of moderate/severe brain injury on MRI. 72 A persistently abnormal EEG background pattern at 48 hours, combined with an abnormal early MRI, was strongly predictive of poor outcome. 72 Quantitative EEG variables such as total EEG power calculated at 9 hours of life, taking a threshold of < 10 μV 2 , helped in early stratification of a high-risk cohort who subsequently had brainstem injury, which is uniformly associated with poor prognosis and high mortality.…”

“…72 A persistently abnormal EEG background pattern at 48 hours, combined with an abnormal early MRI, was strongly predictive of poor outcome. 72 Quantitative EEG variables such as total EEG power calculated at 9 hours of life, taking a threshold of < 10 μV 2 , helped in early stratification of a high-risk cohort who subsequently had brainstem injury, which is uniformly associated with poor prognosis and high mortality. 73 Bedside availability of EEG makes it a beneficial tool in HIE to predict the course of illness.…”

Predictors of Outcomes in Hypoxic-Ischemic Encephalopathy following Hypothermia: A Meta-Analysis

“…Seventeen articles reported on aEEG recordings [6,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Nine of those articles used the classification for background pattern by Hellström-Westas et al [32], 3 used the voltage pattern of al Naqueeb et al [33], and 3 studies used both methods.…”

Predictive factors of death in neonates with hypoxic-ischemic encephalopathy receiving selective head cooling

“…In terms of the EEG value, the background EEG pattern can predict neurological complications for term infants with HIE, whereas concomitance of EEG with clinical data such as gestational age, birth weight, brain imaging, and severity of HIE can provide a more accurate assessment of neurological complications. 8,37) Moreover, in infants…”

“…7) However, abnormal amplitude-integrated electroencephalogram (a-EEG) for 48h along with early abnormal MRI is a strong predictor of poor neurodevelopment. 8) Except for clinical manifestations, the use of a-EEG can be help predict brain damage of neonates following asphyxia. 9) To date, various studies have used neonatal status at birth, the severity of HIE, EEG, biomarkers and brain MRI to predict outcome in infants with HIE.…”