A simple EEG-based tool to guide therapeutic hypothermia decisions in neonatal hypoxic-ischemic encephalopathy

Accurate identification of hypoxic-ischemic brain injury in the early neonatal period is essential for initiating therapeutic hypothermia (TH) within 6 hours of birth to optimize neurodevelopmental outcomes. We aimed to develop a simple decision-making tool for identifying term neonates with hypoxic-ischemic encephalopathy (HIE) based on features of conventional electroencephalograms (EEG) recorded within 6 hours of birth.

EEG recordings from 100 full-term neonates with HIE were graded by pediatric neurologists for severity. Amplitude in slow frequency bands was analyzed, focusing on delta (0.5-4 Hz) spectral power. Temporal fluctuations of delta power characterized each HIE grade, with joint level and duration probability densities estimated for delta oscillation power. This study is registered on clinicaltrials.gouv (NCT05114070).

These 2D EEG representations effectively distinguish mild HIE cases from those requiring hypothermia, achieving 98% accuracy, 99% sensitivity, 99% positive predictive value, 94% negative predictive value, an F1 score of 99%, and a false alarm rate of only 6%. This system accurately discriminates mild from moderate or severe HIE, with only one mild case mistakenly identified as requiring hypothermia and one moderate case erroneously flagged for treatment.

Quantized probability densities of delta spectral features from early EEG (within 6 hours of birth) revealed significant differences between mild and moderate/severe HIE, enabling accurate discrimination of candidates for TH.

Simple, interpretable biomarkers from early EEG can provide an efficient visual clinical decision support tool to identify full-term neonates with HIE eligible for therapeutic hypothermia.