The prognostic role of evoked potentials in neonatal hypoxic-ischemic insult

Abstract

Neonatal encephalopathy is a significant cause of infant mortality and morbidity with risk of neurological sequelae in the survivors of neonates admitted to Neonatal (N) Intensive Care Unit (ICU). The EEG and Evoked Potentials (EPs) are very informative in the ICU. In particular, it is known that the SomatoSensory (SS) EPs are the best single indicator of early prognosis in adults and children patients with traumatic and/or hypoxic-ischemic coma compared to the Glasgow Coma Scale (GCS) and CTscan. Most paediatric studies excluded newborns in an attempt to eliminate the age effects, because of the structural and functional immaturity of somatosensory system. In fact, newborns differ from adults and paediatric patients for many aspects: hypoxic-ischemic aetiology, SSEPs normative data, grading and predictive values, timing and techniques recording, clinical scales of evaluation. Recently a diagnostic and predictive role of early SSEPs has been established in perinatal hypoxic-ischemic. We reported a literature review of early diagnostic/prognostic role of SSEPs and our preliminary neurophysiological data of prospective study in mild or severe perinatal hypoxic-ischemic insult.

Multimodal neurophysiological monitoring in healthy infants born at term: normative continuous somatosensory evoked potentials data

“…We used a stimulation frequency (1.1Hz) lower than that commonly used in adults because it is more appropriate to the immaturity of the newborn infant's nervous system . SEP‐C measurements were performed in agreement with Bongers‐Schokking et al, who advocate that SEP recording in newborn infants should involve use of a band‐pass filter of 1–100Hz with a low number of stimuli (25–50), paying close attention to the behavioural state of the infant.…”

“…The prognostic importance of SEPs in anoxic damage in adults and in children is well known, and there is already evidence in the literature of the usefulness of this test as an early prognostic indicator in the neonatal period …”

“…Our data show that SEP‐C is always present in the healthy newborn infant so the bilateral cortical responses present in the asphyxiated newborn infant strengthen the predictive positive value. On the other hand, bilateral absence can represent a negative predictive value if all recording parameters indicated in neonates are taken into consideration …”

“…Recently, SEPs have been assessed in paediatric patients, as their patterns are more stable and less affected by drugs than aEEG and VEEG, thus providing more accurate diagnosis of possible cerebral injuries. 1,9,10 There is a growing body of literature that demonstrates the strict prognostic correlation between early lack of SEP cortical components and the development of cerebral palsy 11 and neurodevelopmental impairment 12,13 in infants with moderate or severe hypoxic-ischemic encephalopathy, although caution has been suggested in interpreting SEPs during therapeutic hypothermia. 14 In the last 5 years, some studies have compared SEPs from neurologically injured infants with presumably normal SEP patterns from control groups.…”

Uloga evociranih potencijala u diferencijalnoj dijagnozi neuroloskih oboljenja dece i adolescenata

“…Nalaz SSEP značajno korelira sa neurološkim ishodom, ali ne i sa stepenom oštećenja [16]. SSEP je najbolji pojedinačni dijagnostičko-prognostički indikator rane prognoze kod dece sa HIE [17]. Utvrđen je i prediktivni značaj SSEP kod neonatusa sa HIE nakon terapijske primene hipotermije [18].…”