Article Text

other Versions

PDF
Automated electroencephalographic discontinuity in cooled newborns predicts cerebral MRI and neurodevelopmental outcome
  1. Jonathan M Dunne1,
  2. David Wertheim2,
  3. Paul Clarke3,
  4. Olga Kapellou4,
  5. Philippa Chisholm4,
  6. James P Boardman5,
  7. Divyen K Shah1,6
  1. 1Barts and the London Medical School, London, UK
  2. 2Kingston University, London, UK
  3. 3Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  4. 4Homerton University Hospital, London, UK
  5. 5MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
  6. 6Royal London Hospital, London, UK
  1. Correspondence to Dr Divyen K Shah, Royal London Hospital, London E1 1BB, UK; divyen.shah{at}bartshealth.nhs.uk

Abstract

Background and hypothesis Prolonged electroencephalographic (EEG) discontinuity has been associated with poor neurodevelopmental outcomes after perinatal asphyxia but its predictive value in the era of therapeutic hypothermia (TH) is unknown. In infants undergoing TH for hypoxic-ischaemic encephalopathy (HIE) prolonged EEG discontinuity is associated with cerebral tissue injury on MRI and adverse neurodevelopmental outcome.

Method Retrospective study of term neonates from three UK centres who received TH for perinatal asphyxia, had continuous two channel amplitude-integrated EEG with EEG for a minimum of 48 h, brain MRI within 6 weeks of birth and neurodevelopmental outcome data at a median age of 24 months. Mean discontinuity was calculated using a novel automated algorithm designed for analysis of the raw EEG signal.

Results Of 49 eligible infants, 17 (35%) had MR images predictive of death or severe neurodisability (unfavourable outcome) and 29 (59%) infants had electrographic seizures. In multivariable logistic regression, mean discontinuity at 24 h and 48 h (both p=0.01), and high seizure burden (p=0.05) were associated with severe cerebral tissue injury on MRI. A mean discontinuity >30 s/min-long epoch, had a specificity and positive predictive value of 100%, sensitivity of 71% and a negative predictive value of 88% for unfavourable neurodevelopmental outcome at a 10 µV threshold.

Conclusions In addition to seizure burden, excessive EEG discontinuity is associated with increased cerebral tissue injury on MRI and is predictive of abnormal neurodevelopmental outcome in infants treated with TH. The high positive predictive value of EEG discontinuity at 24 h may be valuable in selecting newborns with HIE for adjunctive treatments.

  • Neonatology
  • Neurology

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.