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Eur J Paediatr Neurol. 2016 Nov;20(6):855-864. doi: 10.1016/j.ejpn.2016.06.003. Epub 2016 Jun 20.

Role of EEG background activity, seizure burden and MRI in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischaemic encephalopathy in the era of therapeutic hypothermia.

Author information

1
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands.
2
Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Wilton, Co. Cork, Ireland.
3
Clinical Neurosciences, UCL-Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
4
Department of Neonatology, Karolinska University Hospital, SE-171 77 Stockholm, Sweden.
5
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands. Electronic address: l.s.devries@umcutrecht.nl.

Abstract

OBJECTIVE:

To investigate the role of EEG background activity, electrographic seizure burden, and MRI in predicting neurodevelopmental outcome in infants with hypoxic-ischaemic encephalopathy (HIE) in the era of therapeutic hypothermia.

METHODS:

Twenty-six full-term infants with HIE (September 2011-September 2012), who had video-EEG monitoring during the first 72 h, an MRI performed within the first two weeks and neurodevelopmental assessment at two years were evaluated. EEG background activity at age 24, 36 and 48 h, seizure burden, and severity of brain injury on MRI, were compared and related to neurodevelopmental outcome.

RESULTS:

EEG background activity was significantly associated with neurodevelopmental outcome at 36 h (p = 0.009) and 48 h after birth (p = 0.029) and with severity of brain injury on MRI at 36 h (p = 0.002) and 48 h (p = 0.018). All infants with a high seizure burden and moderate-severe injury on MRI had an abnormal outcome. The positive predictive value (PPV) of EEG for abnormal outcome was 100% at 36 h and 48 h and the negative predictive value (NPV) was 75% at 36 h and 69% at 48 h. The PPV of MRI was 100% and the NPV 85%. The PPV of seizure burden was 78% and the NPV 71%.

CONCLUSION:

Severely abnormal EEG background activity at 36 h and 48 h after birth was associated with severe injury on MRI and abnormal neurodevelopmental outcome. High seizure burden was only associated with abnormal outcome in combination with moderate-severe injury on MRI.

KEYWORDS:

EEG; HIE; Hypothermia; MRI; Neurodevelopmental outcome; Seizure burden

PMID:
27370316
DOI:
10.1016/j.ejpn.2016.06.003
[Indexed for MEDLINE]

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