Early EEG Findings in Hypoxic-Ischemic Encephalopathy Predict Outcomes at 2 Years

Murray, Deirdre M.; Boylan, Geraldine B.; Ryan, C. Anthony; Connolly, Seán

doi:10.1542/peds.2008-2190

Cited by 247 publications

(258 citation statements)

References 23 publications

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“…This is highly consistent with clinical evidence that in infants with moderate to severe HIE, more rapid recovery of sleep wake cycling within the first 36 to 48 hours of life is associated with a significantly better outcome. 17,18 Interestingly, in contrast with the present study, there is evidence that hypothermia may delay but did not prevent recovery of sleep state cycling in infants with favorable outcomes. 19 Speculatively, this apparent difference may reflect the severity of cortical neuronal loss in our paradigm or the use of sedatives and anticonvulsants in clinical practice.…”

Section: Discussioncontrasting

confidence: 99%

How Long is Too Long for Cerebral Cooling after Ischemia in Fetal Sheep?

Davidson

Wassink

Yuill

et al. 2015

J Cereb Blood Flow Metab

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Therapeutic hypothermia can partially reduce long-term death and disability in neonates after hypoxic-ischemic encephalopathy. The aim of this study was to determine whether prolonging the duration of cooling from 3 days to 5 days could further improve outcomes of cerebral ischemia in near-term fetal sheep. Fetal sheep (0.85 gestation) received 30 minutes bilateral carotid artery occlusion followed by 3 days of normothermia (n = 8), 3 days of hypothermia (n = 8), or 5 days of hypothermia (n = 8) started 3 hours after ischemia. Sham controls received sham ischemia followed by normothermia (n = 8). Cerebral ischemia was associated with profound loss of electroencephalography power and spectral edge, with greater and more rapid recovery in both hypothermia groups (P o0.05). Ischemia was associated with severe loss of neurons in the cortex, hippocampus and thalamus (P o 0.05), with a significant improvement in both hypothermia groups. However, the ischemia-3-day hypothermia group showed greater neuronal survival in the cortex and dentate gyrus compared with ischemia-5-day hypothermia (P o 0.05). Ischemia was associated with induction of iba1-positive microglia, which was attenuated in both hypothermia groups (P o 0.05). Extending the duration of delayed therapeutic hypothermia from 3 to 5 days did not improve outcomes after severe ischemia, and was associated with reduced neuronal survival in some regions.

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Section: Discussioncontrasting

confidence: 99%

How Long is Too Long for Cerebral Cooling after Ischemia in Fetal Sheep?

Davidson

Wassink

Yuill

et al. 2015

J Cereb Blood Flow Metab

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“…MRI assists in the prediction of the severity and type of neurodevelopmental delay;17 however, electrographic grade of HIE has been shown to be as useful as MRI for evaluating the severity of brain injury after perinatal asphyxia 4, 17…”

Section: Discussionmentioning

confidence: 99%

“…We excluded neonates with evidence of perinatal infection, metabolic or congenital abnormalities. This study was a retrospective analysis of two cohorts of neonates prospectively recruited to cEEG studies of neonates at high risk of seizures 4, 15. The modified Sarnat score (Levene) for HIE was performed in all neonates at 24 hours after birth during recruitment of both studies.…”

Section: Methodsmentioning

confidence: 99%

Seizure burden and neurodevelopmental outcome in neonates with hypoxic–ischemic encephalopathy

Kharoshankaya

Stevenson

Livingstone

et al. 2016

Develop Med Child Neuro

187

149

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AimTo examine the relationship between electrographic seizures and long‐term outcome in neonates with hypoxic–ischemic encephalopathy (HIE).MethodFull‐term neonates with HIE born in Cork University Maternity Hospital from 2003 to 2006 (pre‐hypothermia era) and 2009 to 2012 (hypothermia era) were included in this observational study. All had early continuous electroencephalography monitoring. All electrographic seizures were annotated. The total seizure burden and hourly seizure burden were calculated. Outcome (normal/abnormal) was assessed at 24 to 48 months in surviving neonates using either the Bayley Scales of Infant and Toddler Development, Third Edition or the Griffiths Mental Development Scales; a diagnosis of cerebral palsy or epilepsy was also considered an abnormal outcome.ResultsContinuous electroencephalography was recorded for a median of 57.1 hours (interquartile range 33.5–80.5h) in 47 neonates (31 males, 16 females); 29 out of 47 (62%) had electrographic seizures and 25 out of 47 (53%) had an abnormal outcome. The presence of seizures per se was not associated with abnormal outcome (p=0.126); however, the odds of an abnormal outcome increased over ninefold (odds ratio [OR] 9.56; 95% confidence interval [95% CI] 2.43–37.67) if a neonate had a total seizure burden of more than 40 minutes (p=0.001), and eightfold (OR: 8.00; 95% CI: 2.06–31.07) if a neonate had a maximum hourly seizure burden of more than 13 minutes per hour (p=0.003). Controlling for electrographic HIE grade or treatment with hypothermia did not change the direction of the relationship between seizure burden and outcome.InterpretationIn HIE, a high electrographic seizure burden is significantly associated with abnormal outcome, independent of HIE severity or treatment with hypothermia.

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“…The medium term modulation is useful for differentiating between quiet and active sleep in the healthy newborn (such sleep states are not always seen in newborns with seizure), [14]. The short term modulation, associated with discontinuity in the EEG, is useful for prognosis and determining sleep state (burst-suppression has prognostic implications and tracé alternant is used to determine quiet sleep), [18]. The colouring of this spectrum varies on the medium and long term [14], [25], [28].…”

Section: B Model Of Newborn Eeg Backgroundmentioning

confidence: 99%

“…The electroencephalogram (EEG) measures the electrical activity of the brain and is used in neonatology to assist in the diagnosis of conditions such as hypoxic-ischaemic encephalopathy, meningitis and stroke, and can be used to predict the neurodevelopmental outcome of the newborn [16], [18].…”

mentioning

confidence: 99%