Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes

Lugli, Licia; Guidotti, Isotta; Pugliese, Marisa; Roversi, Maria Federica; Bedetti, Luca; Muttini, E Della Casa; Cavalleri, Francesca; Todeschini, Alice; Genovese, Maurilio; Ori, Luca; Amato, Maria Pia; Miselli, Francesca; Lucaccioni, Laura; Bertoncelli, Natascia; Candia, Francesco; Maura, Tommaso; Ferrari, Fabrizio; Berardi, Alberto

doi:10.3390/children9081194

Cited by 3 publications

(1 citation statement)

References 37 publications

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“…Lower GA is well described to be associated with neurodevelopment impairments and mortality. [3,[37][38][39] In our cohort, this result was clear, showing survival rates without serious sequelae of over 88% from 29 weeks of GA onwards. Because lower GA is related to more risk of morbidities, the literature is more centered in EPT, so there are limited studies about neurodevelopment outcomes in VPT.…”

Section: Discussionmentioning

confidence: 63%

Evaluation of Survival and Neurodevelopmental Outcomes in Neonates Born Very Preterm

Camacho-Sampaio,

Cordeiro,

Leuzinger-Dias

et al. 2024

Preprint

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Preterm infants are a vulnerable population at high risk for mortality, morbidity, and neurodevelopmental impairments that carry lifelong consequences. Knowledge of survival and sequelae by gestational age is of great importance in order to be able to guide parents and health professionals. The aim of this study is to evaluate perinatal morbidity, mortality and neurodevelopment impairment by gestational age (GA) and analyze the impact of perinatal factors on neurodevelopment outcomes of very preterm (VPT) infants. We conducted a retrospective cohort study off all infants born with < 32 weeks of GA, admitted to the Neonatal Intensive Care Unit in a tertiary maternity hospital from 2013 to 2021. Neurodevelopment was assessed at 24 months of post-menstrual-age, using Griffiths Mental Developmental Scales II (GMDS-II). Moderate to severe neurodevelopment impairment (NDI) was considered in the presence of at least one of the following: global development quotient GMDS-II < 70, cerebral palsy (CP), severe visual impairment or profound sensorineural deafness. There were 311 VPT infants assessed for eligibility, 38 (10.9%) neonatal deaths and 37 (11.9%) losses to follow-up. Neurodevelopment evaluation was performed in 274 infants, 6.2% had moderate to severe NDI. GMDS-II global score < 70 was verified in 4.7%. CP was diagnosed in 3.3%, profound sensorineural deafness in 0.7% and severe visual impairment in 0.7%. The survival and survival without NDI were inversely related to GA. At 25 weeks of GA the survival rate without sequelae exceeded deaths and from 29 weeks the survival rate without NDI was ≥ 88%. In multivariate logistic regression analysis, GA was a protective factor for moderate to severe NDI or death (aOR 0.66; CI 95% 0.46–0.95), whereas being male (aOR 3.43; CI 95% 1.62–7.23) and resuscitation with tracheal intubation (aOR 6.36; CI 95% 2.90-13.59) were independent risk factors. Gestational age is the most significant and independent predictor of NDI. This work provides information not only on survival, but also on neurodevelopment in VPT stratified according to GA, and allows us to inform parents and health care professionals of the risks inherent in this population.

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Section: Discussionmentioning

confidence: 63%

Evaluation of Survival and Neurodevelopmental Outcomes in Neonates Born Very Preterm

Camacho-Sampaio,

Cordeiro,

Leuzinger-Dias

et al. 2024

Preprint

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Neurodevelopmental outcome of neonatal seizures: A longitudinal study

Lugli,

Bariola,

Guidotti

et al. 2024

European Journal of Paediatric Neurology

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The Motor Optimality Score—Revised Improves Early Detection of Unilateral Cerebral Palsy in Infants with Perinatal Cerebral Stroke

Bertoncelli,

Corso,

Bedetti

et al. 2024

Children

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Background: Neonatal cerebral stroke includes a range of focal and multifocal ischemic and hemorrhagic brain lesions, occurring in about one of 3000 live births. More than 50% of children with neonatal stroke develop adverse outcomes, mainly unilateral cerebral palsy. Asymmetries in segmental movements at three months have been proven to be an early sign of CP in infants with unilateral brain damage. Recognition of additional early signs could enhance prognostic assessment and enable an early and targeted intervention. Aim: The aim of the study was to assess early signs of CP in infants with arterial cerebral stroke through the General Movements Assessment and the Motor Optimality Score—Revised (MOS-R). Method: Twenty-four infants born at term (12 females and 12 males) diagnosed with ACS, and 24 healthy infants (16 females and 8 males) were assessed. The GMs (fidgety movements) and MOS-R were assessed from videos recorded at 11–14 weeks of post-term age. Cognitive and motor outcomes were assessed at 24 months using the Griffiths III developmental quotient and Amiel-Tison neurological examination. The gross motor function classification system expanded and revised (GMFCS-E&R) was adopted to categorize CP. Results: Among infants with ACS, 21 (87.5%) developed unilateral CP. Most of them showed non-disabling CP (14 had GMFCS-E&R grade 1 [66.6%], 6 grade 2 [28.6%], and 1 grade 5 [4.8%]). Fidgety movements (FMs) were absent in 17 (70.8%), sporadic in 4 (16.7%) infants, and normal in 3 (12.5%). Segmental movement asymmetry was found in 22/24 (91.7%). According to the MOS-R, motor items (kicking, mouth movements), postural patterns (midline centered head, finger posture variability), and movement character (monotonous and stiff) were statistically different among infants with ACS and healthy infants. The MOS-R median global score was lower in the group with ACS compared to the control group (6 vs 26; p < 0.01). FMs, segmental movement asymmetry, and MOS-R global score were significantly correlated with abnormal outcome. MOS-R global scores less than or equal to 13 had 100% specificity and sensitivity in predicting GMFCS-E&R grade ≥ 2 CP in infants with ACS. Conclusions: The rate of CP was high among infants with ACS, but in most cases it showed low GMFCS-E&R grades. The study highlighted a significant correlation between MOS-R, together with absent FMs and unilateral CP in infants with ACS. Moreover, the MOS-R showed high sensitivity and specificity in the prediction of CP. Combined assessment of FMs and MOS-R could help to better identify infants at high risk of developing UCP in a population of infants with ACS. Early identification of precocious signs of unilateral CP is fundamental to providing an early individualized intervention.

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Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes

Cited by 3 publications

References 37 publications

Evaluation of Survival and Neurodevelopmental Outcomes in Neonates Born Very Preterm

Evaluation of Survival and Neurodevelopmental Outcomes in Neonates Born Very Preterm

Neurodevelopmental outcome of neonatal seizures: A longitudinal study

The Motor Optimality Score—Revised Improves Early Detection of Unilateral Cerebral Palsy in Infants with Perinatal Cerebral Stroke

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