Should amplitude-integrated electroencephalography be used to identify infants suitable for hypothermic neuroprotection?

doi:doi:10.1038/sj.jp.7211882

Abstract

Objective:

Amplitude-integrated electroencephalography (aEEG) has been used adjunctively to identify infants suitable for hypothermic neuroprotection following severe intrapartum asphyxia. To determine whether an early aEEG predicts short-term adverse outcome in infants with significant hypoxic–ischemic encephalopathy (HIE) evaluated for hypothermic neuroprotection.

Study Design:

The aEEG recordings were obtained within 6 h of birth in infants greater than or equal to 36 weeks' gestational age during evaluation for possible selective head or whole-body cooling. Recordings were subsequently re-evaluated for both background pattern and voltage abnormalities by a certified reader masked to clinical history and brain-oriented interventions. All infants with moderate or severe HIE evaluated for hypothermic neuroprotection also underwent magnetic resonance imaging (MRI) of the brain at a median postnatal age of 7 days. The predictive value using the aEEG for determining short-term dichotomous outcomes, defined as early death related to HIE, or a characteristic pattern of abnormalities consistent with hypoxic–ischemic injury on the MRI brain scans was assessed.

Result:

Fifty-four infants with moderate or severe HIE were evaluated with aEEG for hypothermic neuroprotection; 34 infants received selective head cooling, 12 infants underwent total body cooling and 8 infants were not cooled. Outcome data, available for 46 of the 54 infants, revealed a poor correlation between the early aEEG and short-term adverse outcomes, with a sensitivity of 54.8% and negative predictive value (NPV) of only 44%.

Conclusion:

Because of the poor NPV of an early aEEG for a short-term adverse outcome, its use as an 'additional selection criterion' for hypothermic neuroprotection may not be appropriate.

Keywords:

hypoxic–ischemic encephalopathy, hypothermic neuroprotection, amplitude-integrated EEG, MRI brain scans

Original Article