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Updated: May 31, 2026
Continuous Video Electroencephalogram during Hypoxia-Ischemia in Neonatal Mice
Published on: June 11, 2020
Early predictors for later epilepsy after therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy
S D Calligaris1, M Jozefkowicz2, M J Martinez Cáceres3
1Department of Neurology, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina.
Background And Objective:
Therapeutic hypothermia (TH) is the standard of care for neonatal hypoxic-ischemic encephalopathy (HIE), yet the risk of neonatal epilepsy remains a significant burden for families and clinicians. We aimed to observe and describe clinical, electrographic, and neuroimaging factors associated with the development of epilepsy by age 2 years in neonates with HIE treated with TH.
Methods:
We conducted a retrospective observational study of neonates (≥36 weeks' gestational age) with moderate-to-severe HIE. Neonatal evaluations included clinical staging, continuous aEEG during a 72-hour cooling period and rewarming, and brain MRI (Weeke scoring). The primary outcome was the diagnosis of epilepsy (International League Against Epilepsy [ILAE] criteria) at 24 months of age.
Results:
Of 127 infants who completed follow-up, 15% (n = 19) developed epilepsy. Multivariate analysis revealed that only deep grey matter injury (Weeke score > 9.5; OR 101.8; 95% CI 6.39-399.6; p = 0.003) and persistent severe aEEG background suppression at 72 h (OR 25.4; 95% CI 1.57-740.2; p = 0.027) remained independent predictors. All patients with epilepsy had concurrent cerebral palsy (Gross Motor Function Classification System [GMFCS] > 3).
Conclusion:
In the era of cooling, structural injury to the deep grey matter and failed aEEG recovery are robust early predictors of epilepsy in HIE. Identifying these factors early facilitates high-risk survivors receiving the intensive multidisciplinary surveillance they require.
