aEEG and Prediction of Outcome in HIE Onset of SWC •  171 babies with HIE were studied •  Median 4me intervals from birth to onset of SWC were signiﬁcantly diﬀerent in babies with mild, moderate or severe HIE •  Good neurodevelopmental outcome was associated with an onset of SWC before 36 hours of age (sensi4vity 8%, speciﬁcity 66.7%, PPV 92%, NPV 48%) Osrekar D, et al. Pediatrics (2005) Fig 2. A, Box plot of time intervals from birth to onset of SWC with regard to the grades o
box, 25th and 75th percentiles; limit lines, the range. B, Relationship between the qualit
Prognostic signi9icance of aEEG patterns in HIE •  30 newborns with HIE were studied during ﬁrst 72 hours aZer birth and their aEEG tracings were assessed by pa[ern recogni4on •  The course of the aEEG pa[ern was examined in rela4on to neurologic outcome at 24 months of age •  Con3nuous normal voltage (CNV) or discon3nuous normal voltage (DNV) prior to 48 hours of life are predic3ve of normal outcome Ter Horst HJ et al. Pediatric Research (2004) siy
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outcome. A p # 0.05 was considered statistically significant.
RESULTS
Longitudinal course of aEEG patterns. Seventeen infants
had severely abnormal aEEG patterns at admission. Fourteen
were admitted before 12 h after birth. In five of them, the aEEG
improved to normal voltage patterns (CNV, DNV) within 12 h
after birth; in two, it improved between 24 and 48 h after birth.
In 10 infants, the aEEG patterns remained severely abnormal
throughout the first 72 h of life or until death, although the
degree of abnormality changed in three of them from lowvoltage patterns to BS.
Thirteen infants had normal (CNV, n $ 6) or mildly abnormal (DNV, n $ 7) aEEG traces at admission. In these infants,
all traces remained of normal voltage, except for two infants. In
one infant, a short period of BS occurred between 24 and 36 h Figure 2. Longitudinal course of aEEG patterns in 30 term asphyxiated
after birth; in the other infant, EA was obvious at ~72 h after neonates, during the first 72 h of life, grouped according to their neurologic
outcomes. , CNV-S; , CNV; , DNV; , CNV/DNV ! EA; , BS; ,
birth.
BS ! EA; , SE; , CLV; , CLV ! EA; , FT.
Epileptic activity on aEEG. In the total group, EA was
recognized on 10 aEEG traces, either as isolated events or as
epileptic status. In two of these infants, the electrographic EA (DNV, CNV, CNV-S) as well. Two infants had additionally
was not clinically evident at all, and in four, it continued or short periods of BS, one of them during the first 12 h after birth
returned electrographically after apparently successful treat- and the other between 24 and 48 h after birth. Another infant
ment of the clinical manifestations. Suspicious clinical signs had a low-voltage pattern (CLV) followed by a long period of
suggestive of seizures that could not be recognized on the BS up to 36 h after birth, intermixed with short periods of
aEEG traces occurred in four infants. All infants with either clinical seizures and EA on aEEG. Finally, one neonate iniclinical or silent seizures were treated with antiepileptic drugs. tially had a DNV trace but got clinical seizures and EA on the
Treatment with antiepileptic drugs never changed a normal aEEG on the third day of life.
Three infants had severe neurologic deficits at follow-up,
pattern into a severely abnormal one, although in some infants,
the pattern became transiently more discontinuous than before, and eight infants died. All but one had severely abnormal
aEEG patterns (BS, CLV, FT) throughout the first 72 h after
for ~30 to 60 min.
The course of aEEG patterns in relation to neurologic birth. Eight of them had in addition episodes of epileptic status
findings at 2 y. Figure 2 displays the longitudinal course of (n $6) or EA superimposed on CLV (n $2).
Prognostic value of aEEG patterns for neurologic outcome
aEEG patterns recorded during the first 72 h after birth of all
infants, grouped according to neurologic outcome. Thirteen at 2 y. A strong correlation existed between the sequence of
were normal
All except
four asphyxiated
showed normal and severely abnormal aEEG patterns and neurologic
Figure 2. infants
Longitudinal
course at
of follow-up.
aEEG patterns
in 30 term
lo
nm
3
d
r
s
y
6
infants in the normothermia group
(P $ .04). With the limitations of small
(death and disability) from 3 to 72
hours in normothermia and hypother-
s
e
6
of
a
FIGURE 2
PPV of an abnormal trace (BS, LV, or FT) to predict poor outcome (death/disability) in hypothermiatreated or normothermia-treated infants at age epochs as indicated on the x-axis.
Effect of hypothermia on aEEG •  74 babies enrolled and their aEEG recordings were recorded for 72 hours and correlated with Bayley II at 18 months •  The PPV at 3-‐6 hours was 84% for normothermia and 59% for hypothermia •  The recovery 4me to normal background was the best predictor of poor outcome 96% in hypothermia and 91% in hypothermia •  Infants with good outcome had normal background pa[ern by 24 hours when treated with normothermia and by 48 hours when treated with hypothermia Thoresen M, et al. Pediatrics (2010) Case study §  Full term infant with cord prolapse §  Cord venous gas 6.8 50 20 8 -‐25 §  Apgar scores 11 and 35 §  Transferred for therapeu4c hypothermia