Limited short-term prognostic utility of cerebral NIRS during neonatal therapeutic hypothermia

Shellhaas, Renée A.; Thelen, Brian J.; Bapuraj, Jayapalli Rajiv; Burns, Joseph W.; Swenson, Aaron W.; Christensen, Mary; Wiggins, Stephanie A.; Barks, John

doi:10.1212/wnl.0b013e31829bfe41

Cited by 39 publications

(43 citation statements)

References 36 publications

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“…In their later work, they included the entire 72-h cooling period. Nevertheless, NIRS variables did not differentiate between those with normal and poor 18-month outcomes [24]. …”

Section: Discussionmentioning

confidence: 99%

“…The strengths of our study are: (a) the number of studied neonates, compared to other published studies of aEEG and NIRS in infants with HIE [8,9,10,23,24]; (b) the homogeneity of our patient population (only HIE II); (c) the detailed analysis of aEEG (including analysis of SWC and seizures); and (d) the combination of aEEG with NIRS data over a total of 102 h.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of Outcome in Neonates with Hypoxic-Ischemic Encephalopathy II: Role of Amplitude-Integrated Electroencephalography and Cerebral Oxygen Saturation Measured by Near-Infrared Spectroscopy

Goeral

Urlesberger²,

Giordano³

et al. 2017

Neonatology

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Background: Few data have been published on the combined use of amplitude-integrated electroencephalography (aEEG) and near-infrared spectroscopy (NIRS) for outcome prediction in neonates cooled for hypoxic-ischemic encephalopathy (HIE). Objective: Our aimwas to evaluate the predictive values and the most powerful predictive combinations of single aEEG and NIRS parameters and the respective cut-off values with regard to short-term outcomes in HIE II. Methods: aEEG and NIRS were prospectively studied at the Medical University of Vienna in the first 102 h of life with regard to magnetic resonance imaging (MRI). Thirty-two neonates diagnosed with HIE II treated with hypothermia were investigated. The measurement period was divided into 6-h epochs. According to MRI, 2 outcome groups were defined and predictive values of aEEG parameters, regional cerebral oxygen saturation (rScO₂), and the additional value of both methods combined were studied. Receiver operating curves (ROC) were obtained and area under the curve (AUC) values were calculated. ROC were then used to detect the optimal cut-off points, sensitivity, specificity, positive predictive values, and negative predictive values. Results: At all time epochs, combined parameter scores were more predictive than single parameter scores. The highest AUC were observed between 18 and 60 h of cooling for the aEEG summation score (0.72-0.84) and for (background pattern + seizures) × rScO₂ (0.79-0.85). At 42-60 h sensitivity was similar between those 2 scores (87.5-90.0%), but the addition of NIRS to aEEG led to an increase in specificity (from 52.4-59.1% to 72.7-90.5%). Conclusions: In HIE II, aEEG and NIRS are important predictors of short-term outcome. The combination of both methods improves prognostication. The highest predictive abilities were observed between 18 and 60 h of cooling.

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“…In their later work, they included the entire 72-h cooling period. Nevertheless, NIRS variables did not differentiate between those with normal and poor 18-month outcomes [24]. …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prediction of Outcome in Neonates with Hypoxic-Ischemic Encephalopathy II: Role of Amplitude-Integrated Electroencephalography and Cerebral Oxygen Saturation Measured by Near-Infrared Spectroscopy

Goeral

Urlesberger²,

Giordano³

et al. 2017

Neonatology

View full text Add to dashboard Cite

show abstract

“…Nitin K. Sethi, New York: Lamberts et al 1 reported on postictal generalized EEG suppression (PGES) inconsistency in patients with multiple convulsions. PGES following convulsive seizures occurs in some but not all patients.…”

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confidence: 99%

“…PGES following convulsive seizures occurs in some but not all patients. 1,2 Patients with PGES are at higher risk for sudden unexpected death in epilepsy (SUDEP), especially if tonic-clonic seizures are uncontrolled; they are on antiepileptic drug (AED) polypharmacy; AED levels are subtherapeutic, indicative of noncompliance; they live alone; or they have coexisting cognitive deficits. 2,3 While the link between PGES and SUDEP is intriguing, there are more variables to be considered than simply the duration or consistency of suppression on EEG after a convulsion.…”

mentioning

confidence: 99%