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Journal of Pediatric Neurology 2020; 18(02): 079-087
DOI: 10.1055/s-0039-1687883
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Combined vEEG and Cerebral Oximetry Results to Determine the Severity of Hypoxic–Ischemic Encephalopathy

Marisa Pacella 
1   Department of Pediatrics, University of Florida, Gainesville, Florida, United States
,
Suman Ghosh
1   Department of Pediatrics, University of Florida, Gainesville, Florida, United States
,
Erik Middlebrook
2   Department of Radiology, University of Florida, Gainesville, Florida, United States
,
Jeffrey Bennett 
2   Department of Radiology, University of Florida, Gainesville, Florida, United States
,
Nikolay Bliznyuk
3   Department of Agricultural and Biological Engineering, University of Florida, Gainesville, Florida, United States
,
Melissa Huene
1   Department of Pediatrics, University of Florida, Gainesville, Florida, United States
,
Nicole Copenhaver
1   Department of Pediatrics, University of Florida, Gainesville, Florida, United States
,
Livia Sura
1   Department of Pediatrics, University of Florida, Gainesville, Florida, United States
,
Michael D. Weiss
1   Department of Pediatrics, University of Florida, Gainesville, Florida, United States
› Author Affiliations Funding Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Further Information

Publication History

05 February 2019

12 March 2019

Publication Date:
30 April 2019 (online)

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Abstract

The objectives of the study were to evaluate the prognostic utility of bedside monitoring tools for hypoxic–ischemic encephalopathy (HIE) outcome and develop a prognostic predictive model. This retrospective study reviewed neonatal HIE treated with hypothermia between 2013 and 2016. Continuous video electroencephalography (vEEG) recordings scored for background electrocerebral activity, seizure, and sleep–wake cycles, and rSO2 data were stratified by magnetic resonance imaging (MRI) severity. The vEEG and rSO2 were combined in a predictive model. The analysis included 38 patients. The rSO2 was significantly higher in the severe group. vEEG showed early and persistent maximal suppression in the severe group. The predictive correlation of the rSO2 improves when combined with the vEEG.

Keywords

hypoxic–ischemic encephalopathy - neonatal - cerebral oximetry
 

  • References

  • 1 Ribeiro PS, Jacobsen KH, Mathers CD, Garcia-Moreno C. Priorities for women's health from the global burden of disease study. Int J Gynaecol Obstet 2008; 102 (01) 82-90
    CrossrefPubMedGoogle Scholar
  • 2 Douglas-Escobar M, Weiss MD. Hypoxic-ischemic encephalopathy: a review for the clinician. JAMA Pediatr 2015; 169 (04) 397-403
    CrossrefPubMedGoogle Scholar
  • 3 Azzopardi DV, Strohm B, Edwards AD. , et al; TOBY Study Group. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009; 361 (14) 1349-1358
    CrossrefPubMedGoogle Scholar
  • 4 Gluckman PD, Wyatt JS, Azzopardi D. , et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365 (9460): 663-670
    CrossrefPubMedGoogle Scholar
  • 5 Barkovich AJ, Miller SP, Bartha A. , et al. MR imaging, MR spectroscopy, and diffusion tensor imaging of sequential studies in neonates with encephalopathy. Am J Neuroradiol 2006; 27 (03) 533-547
    PubMedGoogle Scholar
  • 6 Shankaran S, McDonald SA, Laptook AR. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal magnetic resonance imaging pattern of brain injury as a biomarker of childhood outcomes following a trial of hypothermia for neonatal hypoxic-ischemic encephalopathy. J Pediatr 2015; 167 (05) 987-93.e3
    CrossrefPubMedGoogle Scholar
  • 7 Barkovich AJ, Hajnal BL, Vigneron D. , et al. Prediction of neuromotor outcome in perinatal asphyxia: evaluation of MR scoring systems. Am J Neuroradiol 1998; 19 (01) 143-149
    PubMedGoogle Scholar
  • 8 Massaro AN, Jeromin A, Kadom N. , et al. Serum biomarkers of MRI brain injury in neonatal hypoxic ischemic encephalopathy treated with whole-body hypothermia: a pilot study. Pediatr Crit Care Med 2013; 14 (03) 310-317
    CrossrefPubMedGoogle Scholar
  • 9 Wertheim D, Mercuri E, Faundez JC, Rutherford M, Acolet D, Dubowitz L. Prognostic value of continuous electroencephalographic recording in full term infants with hypoxic ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 1994; 71 (02) F97-F102
    CrossrefPubMedGoogle Scholar
  • 10 Tsuchida TN, Wusthoff CJ, Shellhaas RA. , et al; American Clinical Neurophysiology Society Critical Care Monitoring Committee. American clinical neurophysiology society standardized EEG terminology and categorization for the description of continuous EEG monitoring in neonates: report of the American Clinical Neurophysiology Society critical care monitoring committee. J Clin Neurophysiol 2013; 30 (02) 161-173
    CrossrefPubMedGoogle Scholar
  • 11 Lemmers PM, Zwanenburg RJ, Benders MJ. , et al. Cerebral oxygenation and brain activity after perinatal asphyxia: does hypothermia change their prognostic value?. Pediatr Res 2013; 74 (02) 180-185
    CrossrefPubMedGoogle Scholar
  • 12 Toet MC, Lemmers PM, van Schelven LJ, van Bel F. Cerebral oxygenation and electrical activity after birth asphyxia: their relation to outcome. Pediatrics 2006; 117 (02) 333-339
    CrossrefPubMedGoogle Scholar
  • 13 Awal MA, Lai MM, Azemi G, Boashash B, Colditz PB. EEG background features that predict outcome in term neonates with hypoxic ischaemic encephalopathy: a structured review. Clin Neurophysiol 2016; 127 (01) 285-296
    CrossrefPubMedGoogle Scholar
  • 14 Bonifacio SL, deVries LS, Groenendaal F. Impact of hypothermia on predictors of poor outcome: how do we decide to redirect care?. Semin Fetal Neonatal Med 2015; 20 (02) 122-127
    CrossrefPubMedGoogle Scholar
  • 15 Chandrasekaran M, Chaban B, Montaldo P, Thayyil S. Predictive value of amplitude-integrated EEG (aEEG) after rescue hypothermic neuroprotection for hypoxic ischemic encephalopathy: a meta-analysis. J Perinatol 2017; 37 (06) 684-689
    CrossrefPubMedGoogle Scholar
  • 16 Sewell EK, Vezina G, Chang T. , et al. Evolution of amplitude-integrated electroencephalogram as a predictor of outcome in term encephalopathic neonates receiving therapeutic hypothermia. Am J Perinatol 2018; 35 (03) 277-285
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Evans E, Koh S, Lerner J, Sankar R, Garg M. Accuracy of amplitude integrated EEG in a neonatal cohort. Arch Dis Child Fetal Neonatal Ed 2010; 95 (03) F169-F173
    CrossrefPubMedGoogle Scholar
  • 18 Adelson PD, Nemoto E, Scheuer M, Painter M, Morgan J, Yonas H. Noninvasive continuous monitoring of cerebral oxygenation periictally using near-infrared spectroscopy: a preliminary report. Epilepsia 1999; 40 (11) 1484-1489
    CrossrefPubMedGoogle Scholar
  • 19 Silas R, Sehgal A, Walker AM, Wong FY. Cerebral oxygenation during subclinical seizures in neonatal hypoxic-ischaemic encephalopathy. Eur J Paediatr Neurol 2012; 16 (03) 304-307
    CrossrefPubMedGoogle Scholar
  • 20 Murray DM, Boylan GB, Ryan CA, Connolly S. Early EEG findings in hypoxic-ischemic encephalopathy predict outcomes at 2 years. Pediatrics 2009; 124 (03) e459-e467
    CrossrefPubMedGoogle Scholar
  • 21 Osredkar D, Toet MC, van Rooij LG, van Huffelen AC, Groenendaal F, de Vries LS. Sleep-wake cycling on amplitude-integrated electroencephalography in term newborns with hypoxic-ischemic encephalopathy. Pediatrics 2005; 115 (02) 327-332
    CrossrefPubMedGoogle Scholar
  • 22 Vetrivelan R, Qiu MH, Chang C, Lu J. Role of Basal Ganglia in sleep-wake regulation: neural circuitry and clinical significance. Front Neuroanat 2010; 4: 145
    CrossrefPubMedGoogle Scholar
  • 23 Takenouchi T, Rubens EO, Yap VL, Ross G, Engel M, Perlman JM. Delayed onset of sleep-wake cycling with favorable outcome in hypothermic-treated neonates with encephalopathy. J Pediatr 2011; 159 (02) 232-237
    CrossrefPubMedGoogle Scholar
  • 24 Lemmers PM, Naulaers G, Van Bel F. Clinical application of near-infrared spectroscopy in neonates. In: Kleinman CS, Seri I. , eds. Hemodynamics and Cardiology: Neonatology Questions and Controversies. Philadelphia, PA: Elsevier; 2012: 173 185
    Google Scholar
  • 25 Tichauer KM, Brown DW, Hadway J, Lee TY, St Lawrence K. Near-infrared spectroscopy measurements of cerebral blood flow and oxygen consumption following hypoxia-ischemia in newborn piglets. J Appl Physiol (1985) 2006; 100 (03) 850-857
    CrossrefPubMedGoogle Scholar
  • 26 Ioroi T, Peeters-Scholte C, Post I, Leusink C, Groenendaal F, van Bel F. Changes in cerebral haemodynamics, regional oxygen saturation and amplitude-integrated continuous EEG during hypoxia-ischaemia and reperfusion in newborn piglets. Exp Brain Res 2002; 144 (02) 172-177
    CrossrefPubMedGoogle Scholar