PREDICTIVE VALUE OF AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY ON OUTCOME IN NEONATAL EXTRACORPOREAL MEMBRANE OXYGENATION

Abstract

INTRODUCTION: The early and accurate assessment of cerebral function in neonates who undergo extracorporeal membrane oxygenation (ECMO) may identify high-risk infants who are amenable to neuroprotective strategies or, at least, in need of more detailed neuroimaging and neurodevelopmental follow-up. OBJECTIVE: The specific aims of this study were to assess the clinical utility and long-term predictive value of amplitude-integrated electroencephalography (aEEG) in neonatal ECMO. METHODS: Thirty-four infants who required ECMO for respiratory failure were enrolled in the study prospectively. Serial aEEGs were recorded before, during, and after ECMO and classified by 2 independent interpreters on the basis of background pattern and amplitude criteria. Surviving infants were followed up to 18 to 22 months and assessed with a structured neurologic examination and formal developmental testing by using the Bayley Scales of Infant Development II. The primary outcome was death or neurodevelopmental impairment (defined as moderate-to-severe cerebral palsy and/or a Mental Developmental Index or Psychomotor Development Index score of <70). RESULTS: Preliminary data analysis on the first 20 patients was performed. Thirteen patients survived, 3 died while on ECMO, and 4 died before discharge. All surviving infants were evaluated at follow-up. A severely abnormal aEEG predicted death or moderate-to-severe neurodevelopmental impairment with a sensitivity of 0.85 (95% confidence interval [CI]: 0.70–0.95), a specificity of 0.57 (95% CI: 0.3–0.76), a positive predictive value of 0.79 (95% CI: 0.65–0.88), and a negative predictive value of 0.67 (95% CI: 0.35–0.88). CONCLUSIONS: aEEG is a useful neuromonitoring tool during neonatal ECMO.