Amplitude-Integrated Electroencephalography Evolution and Magnetic Resonance Imaging Injury in Mild and Moderate to Severe Neonatal Encephalopathy

Abstract

Objective This study aimed to describe the evolution of amplitude-integrated electroencephalography (aEEG) in neonatal encephalopathy (NE) during therapeutic hypothermia (TH) and evaluate the association between aEEG parameters and magnetic resonance imaging (MRI) injury.

Study Design aEEG data of infants who underwent TH were reviewed for background, sleep wake cycling (SWC), and seizures. Conventional electroencephalography (cEEG) background was assessed from the reports. Discordance of background on aEEG and cEEG was defined if there was a difference in the severity of the background. MRI injury (total score ≥ 5) was assessed by using the Weeke scoring system.

Results A total of 46 infants were included; 23 (50%) with mild NE and 23 (50%) with moderate to severe NE. Comparing mild NE with moderate to severe NE, the initial aEEG background differed with more mild being continuous (70 vs. 52%), with fewer being discontinuous (0 vs. 22%) and flat tracing (0 vs. 4%), whereas burst suppression (4 vs. 4%) and low voltage (26 vs. 18%) did not differ. There was a notably common discordance between the background assessment on cEEG with aEEG in 82% with continuous and 40% low voltage aEEG background. MRI abnormalities were identified in four infants with mild NE and seven infants with moderate to severe NE. MRI injury was associated with aEEG seizures in infants with moderate to severe NE.

Conclusion aEEG seizures are useful to predict MRI injury in moderate to severe NE infants. There is a large discrepancy between aEEG, cEEG, and MRI in neonates treated by TH.

Key Points

• MRI injury was identified in 29% of moderate NE infants and in 50% of severe NE infants.

• aEEG seizures were associated with MRI injury in the moderate to severe NE infants.

• MRI injury was identified in 16% infants with mild NE.

• Mild NE infants with normal aEEG were unlikely to have MRI injury.

• There was a large discrepancy between aEEG, cEEG, and MRI in infants treated by TH.

Keywords

amplitude-integrated encephalography - magnetic resonance imaging - mild neonatal encephalopathy - moderate to severe neonatal encephalopathy

Authors' Contributions

Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data: K.S., M.E.-D., C.M., K.J.S., E.Y., B.H.W., J.J.V., T.E.I.; drafting the article or revising it critically for important intellectual content: K.S., M.E.-D, C.M., K.J.S., E.Y., B.H.W., J.J.V., T.E.I.; final approval of the version to be published: K.S., M.E.-D., C.M., K.J.S., E.Y., B.H.W., J.J.V., T.E.I.

Ethics Approval and Patient Consent

A waiver of consent was approved by the Partners Healthcare Human Research Committee. This study was performed in accordance with the Declaration of Helsinki.

Publication History

Received: 27 April 2023

Accepted: 26 June 2023

Accepted Manuscript online:
27 June 2023

Article published online:
09 August 2023

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