A Comparison of the Thompson Encephalopathy Score and Amplitude-Integrated Electroencephalography in Infants with Perinatal Asphyxia and Therapeutic Hypothermia

Abstract

Background: In previous studies clinical signs or amplitude-integrated electroencephalography (aEEG)-based signs of encephalopathy were used to select infants with perinatal asphyxia for treatment with hypothermia. Aim: The objective of this study was to compare Thompson encephalopathy scores and aEEG, and relate both to outcome. Subjects and Methods: Thompson scores, aEEG, and outcome were compared in 122 infants with perinatal asphyxia and therapeutic hypothermia. Of these 122 infants, 41 died and 7 had an adverse neurodevelopmental outcome. A receiver operating characteristics (ROC) analysis was also performed. Results: Thompson scores were higher in infants with more abnormal aEEG background patterns (ANOVA, p < 0.001). The ROC analysis demonstrated that a Thompson score of 11 or higher or an aEEG background pattern of continuous low voltage or worse was associated with an adverse outcome (AUC 0.84 for both). Conclusions: High Thompson scores and a suppressed aEEG background pattern are associated with an adverse outcome after perinatal asphyxia and therapeutic hypothermia. Further studies are needed to identify the best technique with which to select patients for therapeutic hypothermia

“Early detection of brain death using the Bispectral Index (BIS) in patients treated by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest”

“…On the other hand, mild therapeutic hypothermia would decrease the activity of brain. When therapeutic hypothermia is used, the predictive value of the aEEG is delayed until 24-36 h [5]. Therefore, when sedatives and anesthetics were used for patients during therapeutic hypothermia after cardiac arrest, the value of BIS was not consistent with the activity of brain.…”

Hypoxic-ischaemic encephalopathy: Identifying newborns who will benefit from therapeutic hypothermia in developing countries

“…In accordance with the large trials, TH should be reserved for neonates ≥36 weeks and ≤6 hours old with evidence of possible intrapartum hypoxia-ischaemia (Apgar score ≤5 at 10 minutes, or continued resuscitation at 10 minutes, or severe acidosis (pH <7/base deficit (BD) ≥16) and an abnormal neurological examination (moderate/severe encephalopathy or clinical seizures or an abnormal aEEG). Although the use of the Thompson score to determine eligibility cannot be disregarded, there is no consensus on the ideal numerical threshold that should be used as Horn et al [30] suggest ≥7, Weeke et al [27] suggest ≥11 and Thorsen et al [28] suggest ≥12, and therefore further large studies are necessary. Institutions using the Thompson score to determine eligibility should select a threshold according to the resources available at that facility, i.e.…”

“…This study also showed that there was no significant difference in the ability of either an early Thompson score or the modified Sarnat stages to predict an abnormal aEEG by 6 hours of age. [30] Weeke et al [27] showed a significant association between the Thompson score and abnormal aEEG patterns. The scores of neonates with discontinuous normal voltage (DNV) and burst suppression (BS) were significantly different (>7 v. ≥10), as were the scores of neonates with BS and continuous low voltage (CLV)/flat trace (FT) (≥10 v. ≥12/15).…”

“…According to the current recommendations, only newborns with moderate or severe encephalopathy qualify for TH, namely a Thompson score >10. However, various TH protocols using the Thompson score include newborns with a score ≤10, [27][28][29] implying that neonates with mild encephalopathy, according to Thompson et al, [7] are receiving TH. However, the number of neonates included in Thompson's study was small, and the numerical threshold with the best sensitivity and specificity to identify neonates with encephalopathy who will benefit from TH is yet to be validated in large clinical trials.…”

“…However, ROC analysis showed that a Thompson score ≥11 was the best cut-off value for an abnormal outcome (sensitivity 76%, specificity 83%), including death, cerebral palsy, severe visual and hearing impairments, and abnormal neurodevelopment. [27] REVIEW Thorsen et al [28] showed that a Thompson score ≥12 had a 3.9-fold increased odds of death before discharge and an 8.4-fold increased odds of severe seizures compared with infants with a Thompson score <12.…”