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Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy
M C Toet1, L Hellström-Westas, F Groenendaal
1Department of Neonatology Wilhelmina Children's Hospital Utrecht The Netherlands.
Insights
Amplitude-integrated electroencephalography (aEEG) effectively predicts outcomes in infants with birth asphyxia. Early aEEG patterns at 3 and 6 hours correlate strongly with neurological prognosis, aiding in identifying infants needing intervention.
Area of Science:
- Neonatal neurology
- Clinical neurophysiology
Background:
- Birth asphyxia poses significant risks to term infants.
- Early prognostication is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To evaluate the prognostic capability of amplitude-integrated electroencephalography (aEEG) at 3 and 6 hours post-birth.
- To correlate aEEG patterns with neurological outcomes in asphyxiated neonates.
Main Methods:
- Studied 73 term asphyxiated infants using Cerebral Function Monitor (CFM).
- Analyzed aEEG tracings (FT, CLV, BS, DNV, CNV) for pattern recognition.
- Correlated aEEG patterns with neurological outcomes at >12 months follow-up.
Main Results:
- aEEG patterns at 3 and 6 hours showed significant correlation with neurological outcomes.
- Sensitivity and specificity for predicting poor outcome were high at 6 hours (0.91 and 0.86, respectively).
- Positive predictive value (PPV) and negative predictive value (NPV) at 6 hours were 86% and 91%, respectively.
Conclusions:
- Amplitude-integrated electroencephalography (aEEG) is a valuable tool for prognostication in neonates with birth asphyxia.
- aEEG can assist in identifying infants who may benefit from therapeutic interventions.
Aim:
To assess the prognostic value of amplitude integrated EEG (aEEG) 3 and 6 hours after birth.
Methods:
Seventy three term, asphyxiated infants were studied (from two different centres), using the Cerebral Function Monitor (CFM Lectromed). The different aEEG tracings were compared using pattern recognition (flat tracing mainly isoelectric (FT); continuous extremely low voltage (CLV); burst-suppression (BS); discontinuous normal voltage (DNV); continuous normal voltage (CNV)) with subsequent outcome.
Results:
Sixty eight infants were followed up for more than 12 months (range 12 months to 6 years). Twenty one out of 68 infants (31%) showed a change in pattern from 3 to 6 hours, but this was only significant in five cases (24%). In three this changed from BS to CNV with a normal outcome. One infant showed a change in pattern from CNV to FT and had a major handicap at follow up. Another infant showed a change in pattern from DNV to BS, and developed a major handicap at follow up. The other 16 infants did not have any significant changes in pattern: 11 infants had CLV, BS, or FT at 3 and 6 hours and died (n = 9) in the neonatal period or developed a major handicap (n = 2). Five infants had a CNV or DNV pattern at 3 and 6 hours, with a normal outcome. The sensitivity and specificity of BS, together with FT and CLV, for poor outcome at 3 hours was 0.85 and 0.77, respectively; at 6 hours 0.91 and 0.86, respectively. The positive predictive value (PPV) was 78% and the negative predictive value (NPV) 84% 3 hours after birth. At 6 hours the PPV was 86% and the NPV was 91%.
Conclusion:
aEEG could be very useful for selecting those infants who might benefit from intervention after birth asphyxia.