Predicting the future for term infants experiencing an acute neonatal encephalopathy: electroencephalogram, magnetic resonance imaging, or crystal ball?

Abstract

In this month's issue, the article entitled “Combined Use of Electroencephalogram and Magnetic Resonance Imaging in Full-Term Neonates With Acute Encephalopathy” by Biagioni et al1 appears. This report describes the authors' extensive clinical experience evaluating infants presenting at (and shortly before) birth with the ominous quartet of fetal heart rate abnormalities, low Apgar scores, the need for resuscitation at birth, and acute neurologic abnormalities during the first 24 hours of life. The purpose of this study was to investigate the relationship between electroencephalogram (EEG) abnormalities and brain lesions seen on magnetic resonance imaging (MRI), and to determine their prognostic value in neonates with hypoxemic-ischemic encephalopathy (HIE). The authors state that HIE is the most common cause of permanent brain injury in the full-term newborn infant. Many previous studies both published, and cited by these authors have suggested that neurologic and developmental outcomes can indeed be predicted in term neonates presenting with acute neonatal encephalopathy. These authors investigate here such predictions using either an early EEG obtained before the third day of life, or an MRI scan obtained later, after the first week and before the first month of life. They differentiate 2-year developmental outcomes as either normal, mildly, moderately, or severely abnormal (or died). They first assigned their 25 cases with acute encephalopathy into 5 EEG background categories, sequenced in order from completely normal to persistently low voltage recordings (most severe), with …