Related Experiment Video
Updated: Jan 19, 2026
Author Spotlight: Assessing the Feasibility of Using Amplitude-Integrated EEG During Neonatal Transport
Published on: June 21, 2024
Early clinical predictors of a severely abnormal amplitude-integrated electroencephalogram at 48 hours in cooled
Alan R Horn1, George H Swingler, Landon Myer
1School of Child and Adolescent Health, Department of Paediatrics, University of Cape Town, Cape Town, South Africa. alan.horn@uct.ac.za
Insights
The Thompson score, assessed in newborns with hypoxic ischaemic encephalopathy (HIE) at 3-5 hours, can predict poor outcomes. A score of 16 or higher strongly indicates a severely abnormal aEEG or death, aiding early identification of infants needing closer monitoring during therapeutic hypothermia.
Area of Science:
- Neonatal Neurology
- Pediatric Critical Care
- Neurodevelopmental Outcomes
Background:
- Hypoxic ischaemic encephalopathy (HIE) is a serious birth complication requiring timely intervention.
- Therapeutic hypothermia improves outcomes in HIE but does not guarantee a favorable result for all infants.
- Identifying infants with poor prognoses despite cooling is crucial for resource allocation and tailored care.
Purpose of the Study:
- To evaluate the predictive value of early clinical assessment (3-5 hours) in cooled infants with HIE.
- To determine if the Thompson encephalopathy score at 3-5 hours predicts a severely abnormal amplitude-integrated electroencephalogram (aEEG) at 48 hours or death.
- To assess individual clinical signs for their predictive capability in HIE.
Main Methods:
- Prospective enrollment of 41 cooled infants (≥36 weeks gestation) with moderate-to-severe HIE.
- Exclusion of moribund infants, those with congenital conditions, or severe cardio-respiratory instability.
- Assessment of the Thompson encephalopathy score and individual clinical signs at 3-5 hours of age.
Main Results:
- A Thompson score ≥16 at 3-5 hours was associated with a severely abnormal aEEG at 6 hours and abnormal short-term outcomes.
- At 48 hours, 75% of infants with a Thompson score ≥16 had a severely abnormal aEEG or died, compared to 18% with a score <16 (p=0.004).
- Multivariate analysis did not identify significant independent predictive value for individual clinical signs.
Conclusions:
- The Thompson score shows promise in identifying infants with HIE who may have poor outcomes despite therapeutic hypothermia.
- A Thompson score of 16 or greater warrants further validation as a prespecified outcome predictor in prospective studies.
- Early clinical assessment using the Thompson score can aid in prognostication for cooled infants with HIE.
Aim:
There is a need to identify infants with hypoxic ischaemic encephalopathy who have a poor outcome despite therapeutic hypothermia. A severely abnormal amplitude-integrated electroencephalogram at 48 h predicts death or disability. Our aim was to determine whether clinical assessment at age 3-5 h predicts a severely abnormal amplitude-integrated electroencephalogram at 48 h or death in cooled infants.
Methods:
Forty-one cooled infants, ≥36 weeks' gestation, with moderate-to-severe hypoxic ischaemic encephalopathy, were prospectively enrolled. Infants who were moribund, had congenital conditions associated with encephalopathy or had severe cardio-respiratory instability were excluded. The predictive abilities of the Thompson encephalopathy score and individual signs at age 3-5 h were assessed.
Results:
All infants with a Thompson score ≥16 at 3-5 h had a severely abnormal amplitude-integrated electroencephalogram at 6 h and an abnormal short-term outcome. At 48 h, 75% had a severely abnormal aEEG or died vs. 18% with a score <16 (p = 0.004). Multivariate analysis did not find a significant independent association with any of the individual signs.
Conclusion:
The Thompson score could be useful to identify infants who will have a poor outcome despite cooling. A score ≥16 should be validated as a prespecified variable in prospective studies.
