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Predictive value of electroencephalogram for term infants with hypoxic-ischemic encephalopathy treated with hypothermia

Presented as a poster at the Neonatal Society 2016 Summer Meeting.

Dubillot Bigot D1, Annan M2, Favrais G1,3, Lopez E1, De Toffol B2,3, Saliba E1,3

1 Réanimation pédiatrique et néonatale, médecine néonatale, CHRU de Tours, Université François Rabelais, Tours, France
2 Neurologie, CHRU de Tours, Université François Rabelais, Tours, France
3 Inserm U930 – « Imagerie et Cerveau » – Université François Rabelais, Tours, France

Background: Electroencephalogram (aEEG and/or raw EEG) is reputed to be one of the best predictors of neurological outcome following HIE in term newborns and was used to select infants into trials of neuroprotection with hypothermia. But its predictive value and the effect of moderate hypothermia on EEG have not previously been examined. Our aim was to evaluate the predictive value of EEG during the first 72 hours on neurodevelopmental outcome at 12 months of age in term asphyxiated newborns treated with hypothermia.

Methods: All children admitted for HIE treated with hypothermia at the University Hospital of Tours since 2009 were included. A first EEG was performed before 6 hours of life (initial EEG) and a continuous video-EEG was recorded during the 72 hours of hypothermia. Neuromotor development was assessed at 12 months with the parental Ages and Stages Questionnaires.

Results: A total of 49 children were included in the study. At 12 months, 20 children had normal development, 3 had a mild to moderate deficit, 16 children had severe disabilities and 10 children died. The presence of seizures over the first 24 hours of life is strongly predictive of severe disability or death at 12 months (aOR = 8.774, 95% CI = 2.533 to 96.076, p = 0.003). At the end of hypothermia, EEG background had improved into 61.2% of cases, remained the same in 26.5%. In children with severe disability, status epilepticus and isoelectric plots were significantly more frequent. In most patients (80%), an isoelectric background in the initial EEG was associated with a poor prognosis (P = 0.005). Discontinuous activity combined with seizures was associated with a severe disability or death at 12 months. The PPV of the initial EEG was 27% and the NPV was 26% concerning the discontinuous EEG.

Conclusion: Inactive EEG and seizures during the first 24 hours of life are associated with a poor neurological outcome. The predictive value for death or disability at 12 months of age of the EEG recorded within 6 h of birth in asphyxiated infants receiving therapeutic hypothermia seems to be lower than EEG recorded at later time during cooling. Continuous monitoring EEG during hypothermia is essential to predict neurological outcome and might help in decision-making by clinicians as well as in providing information to families.

Corresponding author: delphine.bigot@univ-tours.fr

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