Quantitative EEG in babies at risk for hypoxic ischemic encephalopathy after perinatal asphyxia

Abstract

Objective: To evaluate an electroencephalography (EEG)-based index, the Cerebral Health Index in babies (CHI/b), for identification of neonates with high Sarnat scores and abnormal EEG as markers of hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia.Study Design: This is a retrospective study using 30 min of EEG data collected from 20 term neonates with HIE and 20 neurologically normal neonates. The HIE diagnosis was made on clinical grounds based on history and examination findings. The maximum-modified clinical Sarnat score was used to grade HIE severity within 72 h of life. All neonates underwent 2-channel bedside EEG monitoring. A trained electroencephalographer blinded to clinical data visually classified each EEG as normal, mild or severely abnormal. The CHI/b was trained using data from Channel 1 and tested on Channel 2. Result:The CHI/b distinguished among HIE and controls (P<0.02) and among the three visually interpreted EEG categories (P<0.0002). It showed a sensitivity of 82.4% and specificity of 100% in detecting high grades of neonatal encephalopathy (Sarnat 2 and 3), with an area under the receiver operator characteristic (ROC) curve of 0.912. CHI/b also identified differences between normal vs mildly abnormal (P<0.005), mild vs severely abnormal (P<0.01) and normal vs severe (P<0.002) EEG groups. An ROC curve analysis showed that the optimal ability of CHI/b to discriminate poor outcome was 89.7% (sensitivity: 87.5%; specificity: 82.4%). Conclusion:The CHI/b identified neonates with high Sarnat scores and abnormal EEG. These results support its potential as an objective indicator of neurological injury in infants with HIE.

Prognostic Value of Continuous Electroencephalogram Delta Power in Neonates With Hypoxic-Ischemic Encephalopathy

“…Prior studies have correlated qualitative and quantitative EEG metrics to Sarnat stage of encephalopathy. 38,39 Contrary to these findings, using a small cohort of 10 HIE neonates (5 moderate, 5 severe), Burnsed et al found no association between the EEG total Figure 2. The iso-AUC maps for every 3 hours from 9 to 105 hours of life for overall cohort (n ¼ 95).…”

An Automated System for Grading EEG Abnormality in Term Neonates with Hypoxic-Ischaemic Encephalopathy

“…These methods would, nonetheless, require additional post-processing to generate a grading of neonatal EEG. Hathi et al 15. have developed a cerebral health index for babies (CHI/b), a form of automated grading system (AGS), based on quantitative assessment of the EEG.…”