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Original Paper

Prediction of Outcome in Neonates with Hypoxic-Ischemic Encephalopathy II: Role of Amplitude-Integrated Electroencephalography and Cerebral Oxygen Saturation Measured by Near-Infrared Spectroscopy

Goeral K.a · Urlesberger B.c · Giordano V.a · Kasprian G.b · Wagner M.a · Schmidt L.a · Berger A.a · Klebermass-Schrehof K.a · Olischar M.a

Author affiliations

aDivision of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, and bDivision of Neuroradiology and Musculoskeletal Radiology, Department of Radiology, Medical University of Vienna, Vienna, and cDivision of Neonatology, Medical University of Graz, Graz, Austria

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Neonatology 2017;112:193-202

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: January 13, 2017
Accepted: March 08, 2017
Published online: July 14, 2017
Issue release date: October 2017

Number of Print Pages: 10
Number of Figures: 3
Number of Tables: 3

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: https://www.karger.com/NEO

Abstract

Background: Few data have been published on the combined use of amplitude-integrated electroencephalography (aEEG) and near-infrared spectroscopy (NIRS) for outcome prediction in neonates cooled for hypoxic-ischemic encephalopathy (HIE). Objective: Our aim was to evaluate the predictive values and the most powerful predictive combinations of single aEEG and NIRS parameters and the respective cut-off values with regard to short-term outcomes in HIE II. Methods: aEEG and NIRS were prospectively studied at the Medical University of Vienna in the first 102 h of life with regard to magnetic resonance imaging (MRI). Thirty-two neonates diagnosed with HIE II treated with hypothermia were investigated. The measurement period was divided into 6-h epochs. According to MRI, 2 outcome groups were defined and predictive values of aEEG parameters, regional cerebral oxygen saturation (rScO2), and the additional value of both methods combined were studied. Receiver operating curves (ROC) were obtained and area under the curve (AUC) values were calculated. ROC were then used to detect the optimal cut-off points, sensitivity, specificity, positive predictive values, and negative predictive values. Results: At all time epochs, combined parameter scores were more predictive than single parameter scores. The highest AUC were observed between 18 and 60 h of cooling for the aEEG summation score (0.72-0.84) and for (background pattern + seizures) × rScO2 (0.79-0.85). At 42-60 h sensitivity was similar between those 2 scores (87.5-90.0%), but the addition of NIRS to aEEG led to an increase in specificity (from 52.4-59.1% to 72.7-90.5%). Conclusions: In HIE II, aEEG and NIRS are important predictors of short-term outcome. The combination of both methods improves prognostication. The highest predictive abilities were observed between 18 and 60 h of cooling.

© 2017 S. Karger AG, Basel


References

  1. Ehrenstein V: Association of Apgar scores with death and neurologic disability. Clin Epidemiol 2009;1:45-53.
    External Resources
  2. Thayyil S, Chandrasekaran M, Taylor A, Bainbridge A, Cady EB, Chong WK, Murad S, Omar RZ, Robertson NJ: Cerebral magnetic resonance biomarkers in neonatal encephalopathy: a meta-analysis. Pediatrics 2010;125:e382-e395.
  3. Rutherford MA, Pennock JM, Counsell SJ, Mercuri E, Cowan FM, Dubowitz LM, Edwards AD: Abnormal magnetic resonance signal in the internal capsule predicts poor neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy. Pediatrics 1998;102:323-328.
  4. Barkovich AJ, Hajnal BL, Vigneron D, Sola A, Partridge JC, Allen F, Ferriero DM: Prediction of neuromotor outcome in perinatal asphyxia: evaluation of MR scoring systems. AJNR Am J Neuroradiol 1998;19:143-149.
    External Resources
  5. Toet MC, Hellström-Westas L, Groenendaal F, Eken P, de Vries LS: Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy. Arch Dis Child Fetal Neonatal Ed 1999;81:F19-F23.
    External Resources
  6. Thoresen M, Hellström-Westas L, Liu X, de Vries LS: Effect of hypothermia on amplitude-integrated electroencephalogram in infants with asphyxia. Pediatrics 2010;126: e131-e139.
  7. Meek JH, Elwell CE, McCormick DC, Edwards AD, Townsend JP, Stewart AL, Wyatt JS: Abnormal cerebral haemodynamics in perinatally asphyxiated neonates related to outcome. Arch Dis Child Fetal Neonatal Ed 1999;81:F110-F115.
  8. Toet MC, Lemmers PM, van Schelven LJ, van Bel F: Cerebral oxygenation and electrical activity after birth asphyxia: their relation to outcome. Pediatrics 2006;117:333-339.
  9. Ancora G, Maranella E, Grandi S, Sbravati F, Coccolini E, Savini S, Faldella G: Early predictors of short term neurodevelopmental outcome in asphyxiated cooled infants: a combined brain amplitude integrated electroencephalography and near infrared spectroscopy study. Brain Dev 2013;35:26-31.
  10. Zaramella P, Saraceni E, Freato F, Falcon E, Suppiej A, Milan A, Laverda AM, Chiandetti L: Can tissue oxygenation index (TOI) and cotside neurophysiological variables predict outcome in depressed/asphyxiated newborn infants? Early Hum Dev 2007;83:483-489.
  11. Sarnat HB, Sarnat MS: Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol 1976;33:696-705.
  12. Jacobs S, Hunt R, Tarnow-Mordi W, Inder T, Davis P: Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2007;4:CD003311.
  13. Klem GH, Lüders HO, Jasper HH, Elger C: The ten-twenty electrode system of the International Federation. The International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol Suppl 1999;52:3-6.
    External Resources
  14. Hellström-Westas L, Rosén I: Continuous brain-function monitoring: state of the art in clinical practice. Semin Fetal Neonatal Med 2006;11:503-511.
  15. Alderliesten T, Dix L, Baerts W, Caicedo A, van Huffel S, Naulaers G, Groenendaal F, van Bel F, Lemmers P: Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates. Pediatr Res 2016;79:55-64.
  16. Naulaers G, Morren G, Van Huffel S, Casaer P, Devlieger H: Cerebral tissue oxygenation index in very premature infants. Arch Dis Child Fetal Neonatal Ed 2002;87:F189-F192.
  17. Lemmers PM, Zwanenburg RJ, Benders MJ de Vries LS, Groenendaal F, van Bel F, Toet MC: Cerebral oxygenation and brain activity after perinatal asphyxia: does hypothermia change their prognostic value? Pediatr Res 2013;74:180-185.
  18. Si QS, Nakamura Y, Kataoka K: Hypothermic suppression of microglial activation in culture: inhibition of cell proliferation and production of nitric oxide and superoxide. Neuroscience 1997;81:223-229.
  19. Gluckman PD, Wyatt JS, Azzopardi D, Ballard R, Edwards AD, Ferriero DM, Polin RA, Robertson CM, Thoresen M, Whitelaw A, Gunn AJ: Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005;365:663-670.
  20. Pellicer A, Greisen G, Benders MJ, Claris O, Dempsey E, Fumagalli M, Gluud C, Hagmann C, Hellström-Westas L, Hyttel-Sorensen S, Lemmers P, Naulaers G, Pichler G, Roll C, van Bel F, van Oeveren W, Skoog M, Wolf M, Austin T: The SafeBoosC Phase II Randomised Clinical Trial: a treatment guideline for targeted near-infrared-derived cerebral tissue oxygenation versus standard treatment in extremely preterm infants. Neonatology 2013;104:171-178.
  21. Nemoto EM, Yonas H, Kassam A: Clinical experience with cerebral oximetry in stroke and cardiac arrest. Crit Care Med 2000;28:1052-1054.
  22. Van Bel F, Dorrepaal CA, Benders MJ, Zeeuwe PE, van de Bor M, Berger HM: Changes in cerebral hemodynamics and oxygenation in the first 24 hours after birth asphyxia. Pediatrics 1993;92:365-372.
    External Resources
  23. Shellhaas RA, Kushwaha JS, Plegue MA, Selewski DT, Barks JDE: An evaluation of cerebral and systemic predictors of 18-month outcomes for neonates with hypoxic ischemic encephalopathy. J Child Neurol 2015;30:1526-1531.
  24. Shellhaas RA, Thelen BJ, Bapuraj JR, Burns JW, Swenson AW, Christensen MK, Wiggins SA, Barks JD: Limited short-term prognostic utility of cerebral NIRS during neonatal therapeutic hypothermia. Neurology 2013;81:249-255.
  25. Lemmers PM, Dix LM, Toet MC, van Bel F: Limited short-term prognostic utility of cerebral NIRS during neonatal therapeutic hypothermia. Neurology 2014;82:1480-1481.
  26. Dix LM, Van Bel F, Baerts W, Lemmers PM: Comparing near-infrared spectroscopy devices and their sensors for monitoring regional cerebral oxygen saturation in the neonate. Pediatr Res 2013;74:557-563.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: January 13, 2017
Accepted: March 08, 2017
Published online: July 14, 2017
Issue release date: October 2017

Number of Print Pages: 10
Number of Figures: 3
Number of Tables: 3

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: https://www.karger.com/NEO


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