Accuracy of amplitude‐integrated electroencephalography in the prediction of neurodevelopmental outcome in asphyxiated infants receiving hypothermia treatment

Abstract

Both hypothermia and central nervous system (CNS) drugs may alter the predictive accuracy of amplitude-integrated electroencephalography (aEEG) in hypoxic-ischaemic encephalopathy (HIE). The aim was to assess the predictive value of aEEG in hypothermia-treated HIE infants. Furthermore, we intended to investigate the association of cumulative doses of CNS drugs with aEEG recovery. Seventy term HIE infants treated with hypothermia for 72 h were continuously monitored by single-channel aEEG. Doses of administered morphine, phenobarbitone and midazolam were recorded. Poor outcome was defined as death or severe neurodevelopmental delay at 18-24 months (Bayley Scales of Infant Development II), good outcome as absence of these criteria. Poor outcome n = 26, good outcome n = 44. Positive predictive values (PPV) of an abnormal background pattern to predict poor outcome were 0.5 at 6 h; 0.65 at 24 h; 0.82 at 48 h and 0.92 at 60 h. All infants who developed sleep-wake cycling (SWC) had a favourable outcome; the nondevelopment of SWC resulted in a PPV of 0.73 for a poor outcome. Cumulative doses of the investigated drugs did not differ between infants having an onset of a recovered background pattern before or after 24 h. Amplitude-integrated electroencephalography provides reliable prediction of outcome from the 48th hour during hypothermia in HIE infants. Commonly used CNS drugs in HIE infants do not significantly delay aEEG recovery.