The predictive value of continuous aEEG monitoring for neurodevelopmental outcome in infants with hypoxic ischemic encephalopathy receiving hypothermia treatment

Abstract

Objective To study the predictive value of continuous amplitude-integrated electroencephalogram (aEEG) monitoring for the neurodevelopment outcome in infants with hypoxic-ischemic encephalopathy (HIE) receiving hypothermia treatment. Method From April 2014 to May 2016, neonates admitted to our NICU with HIE receiving hypothermia treatment were continuously monitored using aEEG for 96 h, and assigned into moderately and severely abnormal groups according to aEEG results. The aEEG results before hypothermia treatment, within 24 h, 48 h, 72 h and 96 h after hypothermia treatment were recorded. The Bayley Scales of Infant Development Ⅱ examination was performed at 6 months of age. The sensitivity, specificity, positive and negative predictive values and Youden′s index of aEEG for poor outcome at these timepoints was compared. Result A total of 30 neonates were enrolled. Among them 13 were moderately abnormal and 17 were severely abnormal. The gender, gestational age, birth weight and delivery method between two groups were similar (P>0.05). The 1 min Apgar score, arterial pH, base excess (BE) were significantly lower in the severely abnormal group (P<0.05). The neurodevelopment assessment at 6 months of age showed unfavorable outcomes in 16 cases, while the remaining 14 cases had generally good outcomes. The sensitivity and specificity of aEEG before hypothermia treatment for the prediction of poor outcome was 81.3% and 71.4% respectively. The sensitivity and negative predictive values of aEEG within 24 and 48 after hypothermia treatment for poor outcome was 100%. The Youden′s index of aEEG within 72 h after hypothermia treatment for abnormal outcome was the highest 0.661. Conclusion The aEEG before hypothermia treatment alone is not a reliable indicator of poor outcomes in HIE neonates. The aEEG within 72 h after hypothermia is better. Continuous aEEG monitoring during hypothermia in HIE infants is very important because it provides reliable prediction of outcome. Key words: Hypoxia-ischemia, brain; Neurobehavioral manifestations; Hypothermia, induced; Amplitude-integrated electroencephalogram; Prognosis