Neonatal somatosensory evoked potentials persist during hypothermia

Nevalainen, Päivi; Lauronen, Leena; Metsäranta, Marjo; Lönnqvist, Tuula; Ahtola, Eero; Vanhatalo, Sampsa

doi:10.1111/apa.13813

Cited by 16 publications

(24 citation statements)

References 31 publications

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“…Normal SSEPs were associated with good outcomes, while absent or grossly delayed SSEPs particularly bilaterally absent SSEPs increased the odds of a poor neurological outcome. 81 More recently, Garfinkle et al confirmed that SSEPs performed in cooled HIE neonates on mean day of life 11 had a PPV of 36% and NPV of 93% in predicting cerebral palsy, global developmental delay, and/or epilepsy. They raised caution that the majority of HIE infants treated with hypothermia who had an abnormal SSEP in the neonatal period had a normal outcome, suggesting that bilaterally absent SSEP may have a better prognosis than reported in the prehypothermia era.…”

Section: Evoked Potentialmentioning

confidence: 98%

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

2020

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Hypoxic-ischemic encephalopathy (HIE) is a manifestation of perinatal asphyxial insult that continues to evolve over days to weeks following the initial injury. Therapeutic hypothermia has demonstrated that a proportion of this secondary brain injury may indeed be preventable. However, therapeutic hypothermia has also altered the prognostic utility of many bedside tools that are commonly used as predictors of long-term neurodevelopmental outcome in HIE. Clinicians are often confronted with uncertainty when assessing the prognosis of infants with HIE. Improved understanding of the implications and limitations of individual investigations may inform clinical decisions and allow for timely intervention. This review summarizes the predictive value of currently available prognostic markers in HIE infants in the therapeutic hypothermia era, including clinical, biochemical, neurophysiological, physiological, and neuroimaging predictors.

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Section: Evoked Potentialmentioning

confidence: 98%

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

2020

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“…The results of the meta-analysis are shown in Table 3 (pooled sensitivities and specificities with confidence intervals) and Figure 4 (forest plots of sensitivity and specificity as calculated from the original reports). (16,23,24) evaluated the prognostic value of SEPs for neurological outcomes in HT near-term and term infants with perinatal asphyxia and HIE. For SEPs (I 2 =57.9%, random-effects model), pooled sensitivity and specificity were 0.52 (95% CI 0.34-0.69) and 0.76 (95% CI 0.63-0.87) for predicting an unfavorable outcome, and AUC 0.84.…”

Section: Prognostic Value Of Clinical Testsmentioning

confidence: 99%

“…Continued ≤5 µV and upper margin >10 µV or <10 µV (voltage classifications) BS, LV, and FT traces (pattern classification)24 Bayley III and GMFCS; Bayley score <85, GMFCS 3-5, severe visual deficits, or severe bilateral hearing loss…”

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confidence: 99%

Prognostic Value of Clinical Tests in Neonates With Hypoxic-Ischemic Encephalopathy Treated With Therapeutic Hypothermia: A Systematic Review and Meta-Analysis

et al. 2020

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Background and Objective: There remains an unmet clinical need for markers that predict outcomes in the hypothermia-treated (HT) infants with HIE. The aim of this meta-analysis was to investigate the prognostic accuracy of currently available clinical tests performed in the immediate post-natal period for predicting neurological outcomes between 18 months and 3 years of age in HT near-term and term infants with perinatal asphyxia and HIE. Methods: A comprehensive review of the Embase, Cochrane library, and PubMed databases was performed to identify studies that evaluated the prognostic value of clinical tests for neurological outcomes in HT near-term and term infants with perinatal asphyxia and hypoxic-ischemic encephalopathy. Pooled sensitivity and specificity with corresponding 95% confidence intervals and area under the receiver operating characteristic (ROC) curve (AUC) were calculated. Results: Of the 1,144 relevant studies, 26 studies describing four clinical tests conducted in 1458 HT near-term or term infants were included. For predicting an unfavorable neurological outcome, of the imaging techniques, MRI within 2 weeks of birth performed best on sensitivity 0.85 (95% CI 0.79-0.89), specificity 0.72 (95% CI 0.66-0.77), and AUC 0.88; among the neurophysiological tests, multichannel EEG (Electroencephalogram) demonstrated the sensitivity 0.63 (95% CI 0.49-0.76), specificity 0.82 (95% CI 0.70-0.91), and AUC 0.88, and for aEEG (amplitude-integrated electroencephalography) background pattern pooled sensitivity, specificity and AUC were 0.90 (95% CI 0.86-0.94), 0.46 (95% CI 0.42-0.51), and 0.78 whereas for SEPs (Somatosensory evoked potentials), pooled sensitivity and specificity were 0.52 (95% CI 0.34-0.69), 0.76 (95% CI 0.63-0.87), and AUC 0.84, respectively. Liu et al. Clinical Trials Prognosis of HIE Conclusions: In the wake of the era of TH, MRI and neurophysiological tests (aEEG or EEG) were promising predictors of adverse outcomes, while SEPs need high-quality studies to confirm the findings. Continued follow-up of the children and well-designed large prospective studies are essential to determine whether these benefits are maintained in later childhood.

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“…We applied a study routine developed in our hospital where 21-electrode EEG and SEPs are recorded simultaneously ( Nevalainen et al, 2015 , Nevalainen et al, 2017a , Nevalainen et al, 2017b ). The recordings were performed according to clinical need between 15 h and 10 days postnatally (39 of the 50 newborns were recorded within the first four postnatal days).…”

Section: Methodsmentioning

confidence: 99%

“…Though extremely rare, such cases have possibly discouraged wider use of SEPs in outcome prediction after perinatal asphyxia. Recent studies recording SEPs concomitantly with whole-scalp EEG, however, reported no “false bilaterally absent” SEPs and suggested that SEPs do offer an additional method for early outcome prediction at bedside not only in normothermic but also in hypothermia-treated neonates ( Nevalainen et al, 2017a , Nevalainen et al, 2017b ).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of SEPs in asphyxiated newborns using a 4-electrode aEEG brain monitoring set-up

Nevalainen

Marchi

Metsäranta

et al. 2018

Clinical Neurophysiology Practice

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Neonatal somatosensory evoked potentials persist during hypothermia

Abstract: Our findings indicated that SEPs were a reliable tool for evaluating the somatosensory system in asphyxiated neonates in both normothermic and hypothermic conditions.

Cited by 16 publications

References 31 publications

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

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

Prognostic Value of Clinical Tests in Neonates With Hypoxic-Ischemic Encephalopathy Treated With Therapeutic Hypothermia: A Systematic Review and Meta-Analysis

Evaluation of SEPs in asphyxiated newborns using a 4-electrode aEEG brain monitoring set-up

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