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Prediction of outcome after hypoxic-ischemic encephalopathy: a prospective clinical and electrophysiologic study
Romain Mandel1, Alain Martinot, Florence Delepoulle
1Pediatric Intensive Care Unit, the Department of Neurophysiology, University Hospital of Lille, France.
Insights
Predicting outcomes for children with hypoxic-ischemic encephalopathy (HIE) is possible early. Clinical assessment, electroencephalogram (EEG), and sensory evoked potentials (SEPs) help determine prognosis in HIE patients.
Area of Science:
- Pediatric Neurology
- Neonatal Intensive Care
Background:
- Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal brain injury.
- Accurate prognostic tools are crucial for guiding clinical management and parental counseling.
Purpose of the Study:
- To compare the predictive accuracy of clinical history, examination, and electrophysiologic data for HIE prognosis.
- To identify key indicators for predicting outcomes in pediatric HIE cases.
Main Methods:
- Prospective cohort study of 57 mechanically ventilated children with HIE.
- Data collected included clinical factors, electroencephalogram (EEG), and short-latency sensory evoked potentials (SEPs).
Main Results:
- Cardiopulmonary resuscitation duration >10 min and Glasgow Coma Scale <5 at 24h predicted unfavorable outcomes (PPV 91-100%).
- Discontinuous EEG, epileptiform discharges, and absent N20 waves on SEPs were associated with poor prognosis (PPV 100%).
Conclusions:
- Early prognosis in HIE can be achieved through a combination of clinical assessment, EEG, and SEPs.
- These multimodal assessments provide valuable predictive information for HIE patients.
Objectives:
To evaluate and compare the predictive value of history, clinical examination, and biologic and electrophysiologic data regarding the prognosis of children with acute hypoxic-ischemic encephalopathy (HIE).
Study Design:
Prospective cohort of 57 consecutive children who were mechanically ventilated for HIE throughout a 3-year period in a tertiary pediatric intensive care unit at a university hospital in France.
Results:
At 24 hours after admission, 12 patients had died, 3 were awake and 42 showed impaired consciousness or were in a coma, of whom 38% had a favorable outcome. In this group, an initial cardiopulmonary resuscitation duration longer than 10 minutes and a Glasgow Coma Scale <5 at 24 hours after admission were associated with an unfavorable outcome (positive predictive value [PPV] 91%, 100%; sensitivity 50%, 54%). A discontinuous electroencephalogram (EEG), the presence of spikes or epileptiform discharges were associated with an unfavorable outcome (PPV 100% for the 2 criteria; sensitivity 27%, 54%). The bilateral absence of the N20 wave on short-latency sensory evoked potentials (SEPs) had a PPV for unfavorable outcome of 100% (sensitivity 63%).
Conclusions:
The clinical assessment combined with EEG and SEPs allow an early prediction of the prognosis of children with HIE.