Prediction of Neonatal Seizures in Hypoxic-Ischemic Encephalopathy Using Electroencephalograph Power Analyses

Jain, Siddharth; Mathur, Amit M.; Srinivasakumar, Preethi; Wallendorf, Michael; Culver, Joseph P.; Zempel, John

doi:10.1016/j.pediatrneurol.2016.10.019

Cited by 19 publications

(21 citation statements)

References 21 publications

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“…6 We previously reported the potential utility of delta power as a quantitative EEG metric in HIE. 7 Recent studies have evaluated various other quantitative EEG metrics in neonates with HIE, [8][9][10][11] but they examined only a few discrete time periods (eg, in the first 24 hours of life or during rewarming) and/or used EEG data from a limited number of electrodes. As encephalopathy evolves acutely and location of brain injury is variable, only a comprehensive examination of all surface cortical regions throughout therapeutic hypothermia can identify which time point(s) after injury and which EEG lead location(s) are most predictive of the course and severity of encephalopathy.…”

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confidence: 99%

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

et al. 2020

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The objective was to examine the discriminatory ability of electroencephalogram (EEG) delta power in neonates with hypoxic-ischemic encephalopathy (HIE) with well-defined outcomes. Prolonged continuous EEG recordings from term neonates with HIE during therapeutic hypothermia enrolled in a prospective observational study were examined. Adverse outcome was defined as death or severe brain injury by magnetic resonance imaging (MRI); favorable outcome was defined as normal or mild injury by MRI. Neonates were stratified by Sarnat grade of encephalopathy at admission. EEG was partitioned into 10-minute nonoverlapping artifact- and seizure-free epochs. Delta power was calculated and compared between the groups using receiver operating characteristic (ROC) analyses and Wilcoxon rank-sum tests. An area under the ROC curve >0.7 with P <.05 was considered a significant separation between groups. The favorable outcome group (n = 67) had higher delta power than the adverse outcome group (n = 28) across the majority of time periods from 9 to 90 hours of life. Delta power discriminated outcome groups for neonates with moderate encephalopathy (63 favorable and 14 adverse outcome) earlier in cooling (9-42 hours of life) than neonates with severe encephalopathy (21-42 hours of life). Outcome groups were differentiated after 81 hours of life in neonates with moderate and severe encephalopathy. Delta power can distinguish cooled HIE neonates with adverse outcome independently of the encephalopathy grade at presentation. Delta power may be a real-time continuous biomarker of evolving encephalopathy and brain injury/death in neonates with HIE.

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

et al. 2020

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“…In this study, the rate of severe encepha lopathy, according to the Sarnat staging, was significantly higher in the group with seizures. Severity of aEEG correlates with subse quently developing clinical seizures in neonates with HIE [6,16]. The risk of developing epilepsy within 12 months after birth is 12 % in infants with severely abnormal aEEG [37].…”

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confidence: 99%

“…Glass et al [9] reported that there were no significant differenc es in umbilical cord or first arterial blood gas pH or BD between the neonates with seizures and those without seizures. However, an other study showed that prolonged time to normalization of serum lactate was related to the seizure burden [16]. Murray et al [21] stated that PPV of pH < 7.0 was 16 %, PPV of lactate > 10 mmol/L was 16 %, and PPV of BD < − 15 mmol/L was 15 % in prediction of neonatal seizures [25].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Clinical Seizures in Neonates with Hypoxic–ischemic Encephalopathy Treated with Therapeutic Hypothermia

et al. 2022

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Background This study aimed to assess the risk factors for clinical seizures in newborns treated with whole body cooling (WBC) for hypoxic ischemic encephalopathy (HIE). Methods Infants with gestational age≥36 weeks and birth weight≥2.000 g who were treated with WBC due to HIE were retrospectively enrolled in this study. Patients were assigned to two groups: infants without clinical seizures (Group 1) and infants with clinical seizures (Group 2). The two groups were compared to determine the risk factors for the occurrence of clinical seizures. Results A total of 25 patients (Group 1=10 and Group 2=15) were included in the study. Prothrombin time (PT) was determined as independent risk factor for clinical seizures (p=0.046) and the odds ratio for the effect of PT was found as 1.475 (%95 CI:1.006–2.299). PT (area under the curve [AUC]=0.764; p=0.041), and increased cardiac troponin-I (cTnI) (AUC=0.935; p=0.002) were found to be significant risk factors for predicting the occurrence of clinical seizures. The optimal PT cut-off value was 22.7 sec, with a sensitivity and specificity of 45.4% and 90%, respectively; as well as positive and negative predictive value of 83.3% and 60.0%, respectively. The chest compression in the delivery room, severely abnormal amplitude integrated electroencephalography and high encephalopathy score were also found risk factors for occurrence of clinical seizures. Conclusion Chest compression in the delivery room, high encephalopathy score, prolonged PT, and increased cTnI are significant factors for clinical seizures in newborns treated with WBC for HIE.

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“…Además de los hallazgos clínicos, las anormalidades en las imágenes cerebrales y en el electroencefalograma también permiten predecir las deficiencias neurológicas a largo plazo en estos pacientes; dichas alteraciones se asocian con resultados adversos y una evolución clínica deficiente, independientemente de la gravedad de la encefalopatía hipóxicoisquémica o el uso de la hipotermia terapéutica (11)(12)(13)(14).…”

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Inserción “velamentosa”, encefalopatía hipóxico-isquémica y rehabilitación neurológica: reporte de caso

et al. 2021

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La encefalopatía hipóxico-isquémica es una causa frecuente e importante de daño neurológico en recién nacidos a término y prematuros. Un evento centinela de esta condición es la vasa previa, específicamente cuando existe anormalidad de la placenta como la inserción “velamentosa” del cordón umbilical. Algunos reportes evidencian la asociación entre estas dos condiciones, pero son escasos los que dan cuenta del proceso de recuperación y del pronóstico neurológico de los niños afectados por ellas. Se presenta el caso de un paciente, con antecedentes de inserción “velamentosa” del cordón umbilical y encefalopatía hipóxico-isquémica, que recibió hipotermia terapéutica (cool cap). Se describe su proceso de rehabilitación neurológica y se calculó el porcentaje de probabilidad de presentar esta condición frente a la población sin estos factores. El niño tenía cinco años y el puntaje en su prueba de Apgar fue de 0 al minuto y de 2 a los 15 minutos.Desarrolló encefalopatía hipóxico-isquémica grave secundaria a una inserción “velamentosa” del cordón umbilical sin diagnóstico prenatal, con gran compromiso neurológico y multisistémico inicial. El proceso de recuperación incluyó el manejo inicial multidisciplinario en la unidad de cuidados intensivos neonatales y el inicio temprano de habilitación neurológica.Hoy el niño está escolarizado y en terapia integral, no presenta deficiencias motoras ni sensoriales en el examen físico, aunque la prueba neuropsicológica sugiere un riesgo de trastorno por déficit de atención e hiperactividad. Habitualmente, los niños con encefalopatía hipóxico-isquémica grave presentan discapacidad por deficiencias motoras, cognitivas o conductuales.

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Prediction of Neonatal Seizures in Hypoxic-Ischemic Encephalopathy Using Electroencephalograph Power Analyses

Cited by 19 publications

References 21 publications

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

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

Risk Factors for Clinical Seizures in Neonates with Hypoxic–ischemic Encephalopathy Treated with Therapeutic Hypothermia

Inserción “velamentosa”, encefalopatía hipóxico-isquémica y rehabilitación neurológica: reporte de caso

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