Prediction of Short-Term Neurological Outcome in Full-Term Neonates with Hypoxic-Ischaemic Encephalopathy Based on Combined Use of Electroencephalogram and Neuro-Imaging

Abstract

Background: In infants with hypoxic-ischaemic encephalopathy (HIE), prediction of the prognosis is based on clinical, neuro-imaging and neurophysiological parameters.

Methods: EEG, cranial ultrasound, MRI and follow-up findings of 23 infants (GA 35-42 weeks) with HIE were studied retrospectively to assess 1) the contribution of ultrasound, MRI and EEG in predicting outcome, 2) the accuracy of ultrasound as compared to MRI, and 3) whether patterns of brain damage and EEG findings are associated.

Results: An abnormal EEG background pattern was highly predictive of adverse outcome [positive predictive value (PPV) 0.88]. If combined with diffuse white and deep and/or cortical grey matter changes on ultrasound or MRI, the PPV increased to 1.00. Abnormal neuro-imaging findings were also highly predictive of adverse outcome. Abnormal signal intensity in the posterior limb of the internal capsule, and diffuse cortical grey matter damage were associated with adverse outcome. MRI showed deep grey matter changes more frequently than ultrasound. Severely abnormal neuro-imaging findings were always associated with abnormal EEG background pattern.

Conclusions: Both early EEG and neuro-imaging findings are predictive of outcome in infants with HIE. The predictive value of EEG is strengthened by neuro-imaging.

hypoxic-ischaemic encephalopathy - EEG - neuro-imaging - outcome - term infant

References

• 1 Barkovich AJ, Truwit CL. Brain damage from perinatal asphyxia: correlation of MR findings with gestational age.  AJNR. 1990;  11 1087-1096
• 2 Biagioni E, Mercuri E, Rutherford M, Cowan F, Azzopardi D, Frisone MF. et al . Combined use of electroencephalogram and magnetic resonance imaging in full-term neonates with acute encephalopathy.  Pediatrics. 2001;  107 461-468
• 3 Bell AH, Greisen G, Pryds O. Comparison of the effects of phenobarbitone and morphine administration on EEG activity in preterm babies.  Acta Paediatr. 1993;  82 35-39
• 4 Blankenberg FG, Loh N-N, Bracci P, d’Arceuil E, Rhine WD, Norbash AM. et al . Sonography, CT, and MR imaging: a prospective comparison of neonates with suspected intracranial ischemia and hemorrhage.  AJNR. 2000;  21 213-218
• 5 Clancy RR, Legido A. The exact ictal and interictal duration of electroencephalographic neonatal seizures.  Epilepsia. 1987;  28 537-541
• 6 Cowan F. Outcome after intrapartum asphyxia in term infants.  Semin Neonatol. 2000;  5 127-140
• 7 Eken P, Jansen GH, Groenendaal F, Rademaker KJ, Vries LS de. Intracranial lesions in the fullterm infant with hypoxic ischaemic encephalopathy: ultrasound and autopsy correlation.  Neuropediatrics. 1994;  25 301-307
• 8 Eken P, Toet MC, Groenendaal F, Vries LS de. Predictive value of early neuroimaging, pulsed Doppler and neurophysiology in full term infants with hypoxic-ischaemic encephalopathy.  Arch Dis Child Fetal Neonatal Ed. 1995;  73 F75-F80
• 9 Finer NN, Robertson CM, Richards RT, Pinnell LE, Peters KL. Hypoxic-ischemic encephalopathy in term neonates: perinatal factors and outcome.  J Pediatr. 1981;  98 112-117
• 10 Finer NN, Robertson CM, Peters KL, Coward JH. Factors affecting outcome in hypoxic-ischemic encephalopathy in term infants.  Am J Dis Child. 1983;  137 21-25
• 11 Hagberg B, Hagberg G, Olow I. The changing panorama of cerebral palsy in Sweden 1954-1970.  II. Analysis of various syndromes. Acta Paediatr Scand. 1975;  64 193-200
• 12 Hempel MS. Neurological development during toddling age in normal children and children at risk of developmental disorders.  Early Hum Dev. 1993;  34 47-57
• 13 Holmes G, Rowe J, Hafford J, Schmidt R, Testa M, Zimmerman A. Prognostic value of the electroencephalogram in neonatal asphyxia.  Electroencephalogr Clin Neurophysiol. 1982;  53 60-72
• 14 Holmes GL, Lombroso CT. Prognostic value of background patterns in the neonatal EEG.  J Clin Neurophysiol. 1993;  10 323-352
• 15 Keeney SE, Adcock EW, MacArdle CB. Prospective observations of 100 high-risk neonates by high-field (1.5 Tesla) magnetic resonance imaging of the central nervous system. II. Lesions associated with hypoxic-ischemic encephalopathy.  Pediatrics. 1991;  87 431-438
• 16 Levene MI, Sands C, Grindulis H, Moore JR. Comparison of two methods of predicting outcome in perinatal asphyxia.  Lancet. 1986;  1 67-69
• 17 Ment LR, Bada HS, Barnes P, Grant PE, Hirtz D, Papile LA. et al . Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.  Neurology. 2002;  58 1726-1738
• 18 Mercuri E, Ricci D, Cowan FM, Lessing D, Frisone MF, Haataja L. et al . Head growth in infants with hypoxic-ischemic encephalopathy: correlation with neonatal magnetic resonance imaging.  Pediatrics. 2000;  106 2 35-243
• 19 Nelson KB, Grether JK. Potentially asphyxiating conditions and spastic cerebral palsy in infants of normal birth weight.  Am J Obstet Gynecol. 1998;  179 507-513
• 20 Ortibus EL, Sum JM, Hahn JS. Predictive value of EEG for outcome and epilepsy following neonatal seizures.  Electroencephalogr Clin Neurophysiol. 1996;  98 175-185
• 21 Pressler RM, Boylan GB, Morton M, Binnie CD, Rennie JM. Early serial EEG in hypoxic ischaemic encephalopathy.  Clin Neurophysiol. 2001;  112 31-37
• 22 Rutherford MA, Pennock JM, Schwieso JE, Cowan FM, Dubowitz LM. Hypoxic ischaemic encephalopathy: early magnetic resonance imaging findings and their evolution.  Neuropediatrics. 1995;  26 183-191
• 23 Rutherford M, Pennock J, Schwieso J, Cowan F, Dubowitz L. Hypoxic-ischaemic encephalopathy: early and late magnetic resonance imaging findings in relation to outcome.  Arch Dis Child Fetal Neonatal Ed. 1996;  75 F145-F151
• 24 Rutherford MA, Pennock JM, Counsell SJ, Mercuri E, Cowan FM, Dubowitz LMS. et al . Abnormal magnetic resonance signal in the internal capsule predicts poor neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy.  Pediatrics. 1998;  102 323-328
• 25 Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress.  Arch Neurol. 1976;  33 696-705
• 26 Triulzi F, Parazzini C, Righini A. Patterns of damage in the mature neonatal brain.  Pediatr Radiol. 2006;  36 608-620
• 27 Volpe JJ. Hypoxic-ischemic encephalopathy: Neuropathology and pathogenesis. In: Volpe JJ (Eds) Neurology of the newborn. Philadelphia: WB Saunders Company 2001
• 28 Wertheim D, Mercuri E, Faundez JC, Rutherford M, Acolet D, Dubowitz L. Prognostic value of continuous electroencephalographic recording in full term infants with hypoxic ischaemic encephalopathy.  Arch Dis Child. 1994;  71 F97-F102
• 29 Yudkin PL, Johnson A, Clover LM, Murphy KW. Clustering of perinatal markers of birth asphyxia and outcome at the age of five years.  Br J Obstet Gynaecol. 1995;  102 505-506

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