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Early EEG power predicts MRI injury in infants with hypoxic-ischemic encephalopathy

Journal of Perinatology volume 37, pages 541–546 (2017)Cite this article

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Abstract

Objective:

Early identification of infants with hypoxic-ischemic encephalopathy who have adverse outcomes despite neuroprotection with therapeutic hypothermia (TH) is urgently needed. Recent studies have found limited value of amplitude integrated EEG (aEEG) for predicting short-term outcomes in this population. Other quantitative electroencephalography (EEG) variables reflecting EEG amplitude, such as EEG power, could provide early stratification of a high-risk cohort in this population. The aim of the study was to evaluate and compare early EEG power and aEEG as predictors of magnetic resonance imaging (MRI) injury in neonatal hypoxic-ischemic encephalopathy.

Study Design:

We conducted a retrospective cohort analysis of 78 encephalopathic infants treated with TH between January 2009 and April 2013. About 56 infants had no/mild injury on MRI (group A), whereas 22 had moderate/severe MRI injury (group B). Total EEG power (TEP) and aEEG were obtained soon after initiation of hypothermia and then compared for their ability to predict future MRI injury.

Results:

TEP, calculated at a mean age of 8.9 h, was significantly higher in infants in group A as compared to group B (71.6±64.8 vs 26.9±65.3, P=0.02). Odds ratios for predicting moderate-severe MRI injury for TEP<10 μV2, TEP<20 μV2, burst Suppression or worse aEEG pattern were 55 (confidence interval (CI) 6.4 to 471), 12.5 (CI 3.8 to 40.7) and 6.7 (CI 2.0 to 19.8), respectively.

Conclusion:

Early TEP is a reliable predictor of moderate-severe MRI injury in encephalopathic infants undergoing TH and may enable early stratification of infants who may benefit from adjuvant therapeutic interventions.

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Acknowledgements

SJ is funded by Neurological Sciences Academic Development Award at Washington University in St Louis (5K12NS00169018). We would also like to acknowledge the Thrasher Foundation and Intellectual and Developmental Disabilities Research Center (IDDRC—Washington University in St Louis) for their funding support. The funding organizations had no role in design and conduct of the study or collection, management, analysis and interpretation of the data or preparation, review or approval of the manuscript or decision to submit the manuscript for publication.

Author contributions

SJ was involved in design and conceptualization of the study, analysis and interpretation of data, and drafting the manuscript. JZ was involved in conceptualization of the study, interpretation of the data and revising the manuscript for intellectual content. PS was involved in data collection and revising the manuscript for intellectual content. MW conducted the statistical analysis. AM was involved in conceptualization of the study, interpretation of the data and revising the manuscript for intellectual content.

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Authors and Affiliations

  1. Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University School of Medicine, St Louis, MO, USA

    S V Jain & J M Zempel

  2. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    P Srinivasakumar

  3. Division of Biostatistics, Washington University School of Medicine, St Louis, MO, USA

    M Wallendorf

  4. Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA

    A Mathur

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  1. S V Jain
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  4. M Wallendorf
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  5. A Mathur
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Correspondence to S V Jain.

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Jain, S., Zempel, J., Srinivasakumar, P. et al. Early EEG power predicts MRI injury in infants with hypoxic-ischemic encephalopathy. J Perinatol 37, 541–546 (2017). https://doi.org/10.1038/jp.2016.262

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