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Published on: June 21, 2024
Optimal neuromonitoring techniques in neonates with hypoxic ischemic encephalopathy
Valerie Y Chock1, Anoop Rao1, Krisa P Van Meurs1
1Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States.
Insights
Neonatal hypoxic ischemic encephalopathy (HIE) monitoring is crucial for predicting outcomes. Combining continuous electroencephalography (cEEG), near-infrared spectroscopy (NIRS), and other techniques offers the best prognostic information for infants undergoing therapeutic hypothermia.
Area of Science:
- Neonatal Neurology
- Neurocritical Care
- Pediatric Neuromonitoring
Background:
- Hypoxic ischemic encephalopathy (HIE) poses significant risks of mortality and neurodevelopmental impairment in neonates.
- Effective neuromonitoring is essential for accurate diagnosis and prognosis in affected infants.
- Therapeutic hypothermia is a standard treatment for neonatal HIE, necessitating precise monitoring strategies.
Purpose of the Study:
- To review current bedside neuromonitoring techniques applicable to neonates with HIE.
- To evaluate the role of continuous monitoring modalities in assessing cerebral function and oxygenation.
- To discuss the integrated use of various neuromonitoring tools for improved outcome prediction.
Main Methods:
- Review of continuous neuromonitoring techniques: continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), and near-infrared spectroscopy (NIRS).
- Examination of serial bedside techniques: cranial ultrasound, somatic and visual evoked potentials.
- Consideration of heart rate variability as an adjunct monitoring tool.
Main Results:
- Continuous EEG, aEEG, and NIRS provide distinct yet complementary data on cerebral function and oxygen utilization.
- Serial techniques offer valuable information but are limited by their discrete assessment points.
- Integrated application of multiple neuromonitoring modalities shows promise for enhanced prediction.
Conclusions:
- The combined use of cEEG, aEEG, NIRS, and potentially heart rate variability offers the most comprehensive approach to neuromonitoring in neonates with HIE.
- Integrated neuromonitoring strategies are vital for predicting imaging outcomes and long-term neurodevelopmental trajectories.
- This review highlights the importance of tailored neuromonitoring in the context of therapeutic hypothermia for HIE.
Abstract:
Neonates with hypoxic ischemic encephalopathy (HIE) are at significant risk for adverse outcomes including death and neurodevelopmental impairment. Neuromonitoring provides critical diagnostic and prognostic information for these infants. Modalities providing continuous monitoring include continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), near-infrared spectroscopy (NIRS), and heart rate variability. Serial bedside neuromonitoring techniques include cranial ultrasound and somatic and visual evoked potentials but may be limited by discrete time points of assessment. EEG, aEEG, and NIRS provide distinct and complementary information about cerebral function and oxygen utilization. Integrated use of these neuromonitoring modalities in addition to other potential techniques such as heart rate variability may best predict imaging outcomes and longer-term neurodevelopment. This review examines available bedside neuromonitoring techniques for the neonate with HIE in the context of therapeutic hypothermia.
