AEEG Evolution during Therapeutic Hypothermia and Prediction of NICU Outcome in Encephalopathic Neonates

Abstract

Background: Initial aEEG background pattern has been used as a predictor of neurological outcome after asphyxia and has been used as inclusion criterion for trials evaluating efficacy of therapeutic hypothermia in encephalopathic newborns. The utility of continuous aEEG monitoring during hypothermia has not been well described. Objectives: (1) To describe the evolution of aEEG during therapeutic hypothermia in newborns with encephalopathy, and (2) to evaluate the utility of continuous aEEG monitoring during therapeutic hypothermia. Methods: This is a retrospective review of continuous aEEG data from encephalopathic newborns treated with whole-body hypothermia. aEEG segments were scored for background and sleep-wake cycling (SWC). Sensitivity and specificity calculations and logistic regression analyses were performed to evaluate the ability of aEEG to predict death or severe MRI abnormality/significant neurological deficit at discharge. Results: aEEG data from 75 encephalopathic newborns were reviewed. Abnormal aEEG background was predictive of adverse outcome with increasing positive predictive value over the course of hypothermia. Few patients (5%) had early SWC, but 58% developed SWC by rewarming and all had favorable outcome. Conclusions: Persisting aEEG background abnormality beyond 48 h of life and lack of SWC over the course of hypothermia is predictive of adverse NICU outcome in encephalopathic newborns.