Evolution of Amplitude-Integrated Electroencephalogram as a Predictor of Outcome in Term Encephalopathic Neonates Receiving Therapeutic Hypothermia

Elizabeth K. Sewell; Gilbert Vezina; Taeun Chang; Tammy Tsuchida; Kari Harris; Michelande Ridore; Penny Glass; An N. Massaro

doi:10.1055/s-0037-1607212

American Journal of Perinatology, Table of Contents

Am J Perinatol 2018; 35(03): 277-285
DOI: 10.1055/s-0037-1607212

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evolution of Amplitude-Integrated Electroencephalogram as a Predictor of Outcome in Term Encephalopathic Neonates Receiving Therapeutic Hypothermia

Elizabeth K. Sewell^*

¹Division of Neonatology, Children's National Health Systems, Washington, District of Columbia

²Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

,

Gilbert Vezina

³Division of Diagnostic Imaging and Radiology, Children's National Health Systems, Washington, District of Columbia

⁴Department of Radiology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

,

Taeun Chang

⁵Division of Neurophysiology, Epilepsy and Critical Care, Children's National Health Systems, Washington, District of Columbia

⁶Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

,

Tammy Tsuchida

⁵Division of Neurophysiology, Epilepsy and Critical Care, Children's National Health Systems, Washington, District of Columbia

⁶Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

,

Kari Harris

⁵Division of Neurophysiology, Epilepsy and Critical Care, Children's National Health Systems, Washington, District of Columbia

,

Michelande Ridore

¹Division of Neonatology, Children's National Health Systems, Washington, District of Columbia

,

Penny Glass

²Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

⁷Division of Psychology and Behavioral Health, Children's National Health System, Washington, District of Columbia

,

An N. Massaro

¹Division of Neonatology, Children's National Health Systems, Washington, District of Columbia

²Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

› Author Affiliations

Abstract

Objectives This study aims to evaluate the ability of (1) a novel amplitude-integrated electroencephalogram (aEEG) background evolution classification system; and (2) specific hour of life (HOL) cut points when observation of aEEG normalization and development of cycling can predict adverse neurological outcomes in infants with hypoxic–ischemic encephalopathy (HIE).

Study Design Continuous aEEG data of term neonates with HIE were reviewed for background pattern and aEEG cycling from start of monitoring through rewarming. Infants were classified by overall background evolution pattern. Adverse outcomes were defined as death or severe magnetic resonance imaging injury, as well as developmental outcomes in a subset of patients. aEEG characteristics were compared between outcome groups by multivariate regression models, likelihood ratios (LR), and receiver operating characteristic (ROC) curve analyses.

Results Overall, 80 infants receiving therapeutic hypothermia met the inclusion criteria. Background evolution pattern seemed to distinguish outcome groups more reliably than background pattern at discrete intervals in time (LR: 43.9, p value < 0.001). Infants who did not reach discontinuous background by 15.5 HOL, cycling by 45.5 HOL, and normalization by 78 HOL were most likely to have adverse outcomes.

Conclusion Evolution of aEEG in term neonates with HIE may be more useful for predicting outcome than evaluating aEEG at discrete intervals in time.

Keywords

hypoxic–ischemic encephalopathy - monitoring - brain injury - magnetic resonance imaging - neurodevelopmental outcome

Full Text

References

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