Bilateral loss of cortical SEPs predict severe MRI lesions in neonatal hypoxic ischemic encephalopathy treated with hypothermia

Suppiej, Agnese; Cappellari, A.; Talenti, Giacomo; Cainelli, Elisa; Capua, M. Di; Janes, Augusta; Longo, Daniela; Mardari, Rodica; Marinaccio, C; Pro, Stefano; Sciortino, Paola; Trevisanuto, Daniele; Vittorini, Roberta; Manara, Renzo

doi:10.1016/j.clinph.2017.10.020

Cited by 13 publications

(22 citation statements)

References 41 publications

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“…In neonates with HIE undergoing therapeutic hypothermia, absent SSEPs (N20) predicted moderate-to-severe brain injuries captured by early MRI scans with an accuracy of 0.78. 84 At the same time, a multimodal assessment with amplitude-integrated EEG and standard EEG, in addition to brain MRI, was a better predictor of long-term morbidities compared with SSEPs alone. 85 Similarly, good outcomes at 1 year in neonates with HIE were predicted at 24 hours of life by the presence of normal SSEP, normal EEG background activity, and normal systolic cerebral blood flow velocity with a sensitivity of 74% and a specificity of 100%.…”

Section: A Multimodal Approachmentioning

confidence: 89%

Brain Data in Pediatric Disorders of Consciousness: Special Considerations

Ismail

Saleem

Ljubisavljević

2021

Journal of Clinical Neurophysiology

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The diagnosis and management of disorders of consciousness in children continue to present a clinical, research, and ethical challenge. Though the practice guidelines for diagnosis and management of disorders of consciousness in adults are supported by decades of empirical and pragmatic evidence, similar guidelines for infants and children are lacking. The maturing conscious experience and the limited behavioral repertoire to report consciousness in this age group restrict extrapolation from the adult literature. Equally challenging is the process of heightened structural and functional neuroplasticity in the developing brain, which adds a layer of complexity to the investigation of the neural correlates of consciousness in infants and children. This review discusses the clinical assessment of pediatric disorders of consciousness and delineates the diagnostic and prognostic utility of neurophysiological and neuroimaging correlates of consciousness. The potential relevance of these correlates for the developing brain based on existing theoretical models of consciousness in adults is outlined.

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Section: A Multimodal Approachmentioning

confidence: 89%

Brain Data in Pediatric Disorders of Consciousness: Special Considerations

Ismail

Saleem

Ljubisavljević

2021

Journal of Clinical Neurophysiology

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“…We did not analyze data on the EEG background activity because this parameter was variably described in the collected EEG reports and not specifically scored. We also collected the MRI results scored as normal, mild abnormalities, moderate/severe abnormalities [ 12 , 13 ]. Still, they were not included in the statistical analysis because our focus was on early prognostic markers available before the end of TH.…”

Section: Methodsmentioning

confidence: 99%

“…However, severe outcomes are still a challenge even after introduction of Children 2021, 8, 1103 2 of 8 TH [10,11]. Besides the results of clinical trials, a major focus of research is to verify the validity of early prognostic markers [12]. Particularly, there is a need to identify infants with HIE at higher risk of death or severe neurological impairment, despite TH.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Risk Factors for Severe Outcome in the Acute Phase of Neonatal Hypoxic-Ischemic Encephalopathy: A Prospective Cohort Study

et al. 2021

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In the first days after birth, a major focus of research is to identify infants with hypoxic-ischemic encephalopathy at higher risk of death or severe neurological impairment, despite therapeutic hypothermia (TH). This is especially crucial to consider redirection of care, according to neonatal outcome severity. We aimed to seek associations between some neonatal routine parameters, usually recorded in Neonatal Intensive Care Units, and the development of severe outcomes. All consecutive patients prospectively recruited for TH for perinatal asphyxia, born between February 2009 and July 2016, were eligible for this study. Severe outcome was defined as death or major neurological sequelae at one year of age. Among all eligible neonates, the final analysis included 83 patients. Severe outcome was significantly associated with pH and base excess measured in the first hour of life, mode of delivery, Apgar score, Sarnat and Sarnat score, electroencephalogram-confirmed neonatal epileptic seizures, and antiepileptic therapy. Studying univariate analysis by raw relative risk (RR) and 95% confidence intervals (CI), severe outcome was significantly associated with pH (p = 0.011), Apgar score (p = 0.003), Sarnat score (p < 0.001), and Caesarian section (p = 0.015). Conclusions. In addition to clinical examination, we suggest a clinical-electroencephalographic protocol useful to identify neonates at high neurological risk, available before rewarming from TH.

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“…Ambiguity in prognosis is particularly evident in children with mild to moderate conditions. Most studies highlight predictive power based on neonatal parameters and examinations under severe conditions [7][8][9], but predicting functional disturbances, such as psychopathology and cognitive deficits, remains elusive. Furthermore, in clinical practice, infants with HIE who have normal or mildly abnormal short-term outcomes are considered low risk and discharged from the neonatal intensive care unit without dedicated long-term follow-up programs.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes after Neonatal Hypoxic-Ischemic Encephalopathy in the Era of Therapeutic Hypothermia: A Longitudinal, Prospective, Multicenter Case-Control Study in Children without Overt Brain Damage

Cainelli

Vedovelli

Mastretta³

et al. 2021

Children

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Background. Data on long-term outcomes in the era before therapeutic hypothermia (TH) showed a higher incidence of cognitive problems. Since the introduction of TH, data on its results are limited. Methods. Our sample population consisted of 40 children with a history of hypoxic-ischemic encephalopathy (HIE) treated with TH, with an average age of 6.25 years (range 5.5, 7.33), 24 (60%) males; and 33 peers with an average age of 8.8 years (6.08, 9.41), 17 (51%) males. Long-term follow-up data belong to two centers in Padova and Torino. We measured general intelligence (WPPSI-III or WISC-IV) and neuropsychological functioning (language, attention, memory, executive functions, social skills, visual motor abilities). We also administered questionnaires to their parents on the children’s psychopathological profiles and parental stress. Results. We found differences between groups in several cognitive and neuropsychological domains: intelligence, visuomotor skills, executive functions, and attention. Interestingly, IQ test results effectively differentiated between the groups (HIE vs. controls). Furthermore, the incidence of psychopathology appears to be significantly higher in children with HIE (35%) than in control peers (12%). Conclusions. Our study supports previous findings on a higher incidence of neuropsychological, cognitive, and psychopathological sequelae after HIE treated with TH. As hypothesized, TH does not appear to ameliorate the outcome after neonatal HIE in those children who survive without major sequelae.

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Bilateral loss of cortical SEPs predict severe MRI lesions in neonatal hypoxic ischemic encephalopathy treated with hypothermia

Cited by 13 publications

References 41 publications

Brain Data in Pediatric Disorders of Consciousness: Special Considerations

Brain Data in Pediatric Disorders of Consciousness: Special Considerations

Prognostic Risk Factors for Severe Outcome in the Acute Phase of Neonatal Hypoxic-Ischemic Encephalopathy: A Prospective Cohort Study

Long-Term Outcomes after Neonatal Hypoxic-Ischemic Encephalopathy in the Era of Therapeutic Hypothermia: A Longitudinal, Prospective, Multicenter Case-Control Study in Children without Overt Brain Damage

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