Prediction Of Neurological Outcome Research Articles

Brain arrest neurological outcome scale (BrANOS): predicting mortality and severe disability following cardiac arrest.

To create a predictive scale of neurological outcome following cardiac arrest (CA) that incorporates radiological and clinical markers of brain injury. Brain arrest neurologic outcome scale (BrANOS) is a prospective 16-point scale. It consisted of three variables: (1) duration of arrest (DAR), (2) reversed Glasgow coma scale (GCS), and (3) Hounsfield unit (HU) ratio on non-contrast CT scan of the head. Reversed GCS score was defined as 15-GCS (best GCS in the first 24 h). HU ratio was defined as the density ratio of the caudate nucleus over the posterior limb of the internal capsule measured on unenhanced CT scan of the brain. We identified 32 comatose patients who had: (1) CT scan performed within 48 h of event; (2) no previous history of either coma, severe head trauma, cardiac arrest or stroke. Primary outcome was defined as alive or dead. Secondary outcome was the Glasgow outcome score recorded on discharge. Patient demographics were collated from retrospective chart review. Patients' mean age was 63 +/- 3 years (mean +/- S.E.M.); 44% were females. Mortality rate was 81%. Mean DAR was 21 +/- 2 min. Survivors had a significantly lower BrANOS score (8 +/- 2 points) compared to non-survivors (13 +/- 1) (P = 0.006). BrANOS was a strong predictor of mortality alone (ROC = 0.86) and mortality with severe disability combined (ROC = 0.9). The scale had a 100% specificity and positive predictive value. BrANOS is a reliable predictor of neurological outcome following CA. It is the first scale to incorporate clinical and radiological markers of brain injury.

Serum Measurement of Neuron-specific Enolase (NSE), S-100 , and Interleukin-6 (IL-6) for the Prediction of Neurologic Outcome in Pediatric Patients with Moderate to Severe Closed Head Injury

Serum Measurement of Neuron-specific Enolase (NSE), S-100 , and Interleukin-6 (IL-6) for the Prediction of Neurologic Outcome in Pediatric Patients with Moderate to Severe Closed Head Injury

Neonatal general movements: an early predictor for neurodevelopmental outcome in infants with intrauterine growth retardation.

Intrauterine growth retardation plays a significant role in neurodevelopmental outcome. The assessment of general movements during the first 20 weeks is a new method for early detection of brain dysfunction. General movements in 31 infants with asymmetric intrauterine growth retardation and their appropriate for gestational age-matched controls were examined. General movements were scored as normal or abnormal by sequential videotape recordings in the writhing (term to 2 weeks), early fidgety (9-11 weeks), and late fidgety (14-16 weeks) periods. Scores were compared between the groups and correlated with neurodevelopmental outcome at 2 years. The incidence of normal general movements was lower in the intrauterine growth retarded infants than in the controls (P < .001). Significant correlations were found between general movement quality and neurodevelopmental scores in the intrauterine growth retarded group. The fidgety movements were the most sensitive and specific for prediction of neurologic outcome. The general movement assessment can, therefore, serve as an additional tool for examining the neurologic status of the preterm and term intrauterine growth retarded infant.

Recanalization of Cervical Artery Dissection: Influencing Factors and Role in Neurological Outcome

Background and Purpose: Generally, the prognosis for cervical artery dissection (CAD) is uncertain. The recanalization rate of CAD can be up to 85% within 3 months. This study evaluates the variables that might affect recanalization and the role of recanalization as a predictor for neurological outcome. Patients and Results: This study prospectively included 38 patients with acute stroke following occlusion due to CAD (18 males, 20 females, median age 50.5 years, range 16–82). Vertebral and carotid dissections were equally distributed (19 carotid dissections). The recanalization rate was influenced by the presence of hypertension (p = 0.001). Outcomes were dependent on infarct location. Patients with lateral medullary infarction returned to functional independence (p = 0.026), while patients with deep hemispheric infarction tended to have a disabling stroke (p = 0.068). The presence of good collaterals seemed to influence functional independence (p = 0.03). Conclusion: There seemed to be no relationship between outcome and the rate of recanalization following CAD. Recanalization appeared to be a spontaneous mechanism, which could have depended on the intrinsic condition of the vessels. Finally, neurological outcome was dependent on lesion localization and the presence of good collaterals.

Energy dysfunction as a predictor of outcome after moderate or severe head injury: indices of oxygen, glucose, and lactate metabolism.

The purpose of this study was to determine if the relationship between abnormalities in glucose, lactate, and oxygen metabolism were predictive of neurologic outcome after moderate or severe head injury, relative to other known prognostic factors. Serial assessments of the cerebral metabolic rates for glucose, lactate, and oxygen were performed using a modified Kety-Schmidt method. In total, 31 normal control subjects were studied once, and 49 TBI patients (mean age 36+/-16 years, median GCS 7) were studied five times median per patient from postinjury days 0 to 9. Univariate and multivariate analyses were performed. Univariate analysis showed that the 6-month postinjury Glasgow Outcome Scale (GOS) was most strongly associated with the mean cerebral metabolic rate of oxygen (CMRO2) (P = 0.0001), mean arterial lactate level (P = 0.0001), mean arterial glucose (P = 0.0008), mean cerebral blood flow (CBF), (P = 0.002), postresuscitation GCS (P = 0.003), and pupillary status (P = 0.004). Brain lactate uptake was observed in 44% of all metabolic studies, and 76% of patients had at least one episode of brain lactate uptake. By dichotomized GOS, patients achieving a favorable outcome (GOS 4-5) were distinguished from those with an unfavorable outcome (GOS1-3) by having a higher CMRO2 (P = 0.003), a higher rate of abnormal brain lactate uptake relative to arterial lactate levels (P = 0.04), and lesser degrees of blood-brain barrier damage based on CT findings (P = 0.03). During the first 6 days after moderate or severe TBI, CMRO2 and arterial lactate levels are the strongest predictors of neurologic outcome. However, the frequent occurrence of abnormal brain lactate uptake despite only moderate elevations in arterial lactate levels in the favorable outcome patients suggests the brain's ability to use lactate as a fuel may be another key outcome predictor. Future studies are needed to determine to what degree nonglycolytic energy production from alternative fuels such as lactate occurs after TBI and whether alternative fuel administration is a viable therapy for TBI patients.

Proton magnetic resonance spectroscopy improves outcome prediction in perinatal CNS insults.

Prediction of neurologic outcome is difficult in neonates with acute nervous system injury. Previous studies using proton magnetic resonance spectroscopy ((1)H-MRS) have been used to predict short-term neurologic outcome in neonates with a variety of neurologic insults. We were interested in determining the effectiveness of combining clinical evaluation and spectroscopy obtained at the time of injury in predicting neurologic outcome at 24 months. We studied 33 neonates with acute central nervous system injury, 5.8+/-3.7 days of injury, owing to hypoxic-ischemic encephalopathy. Neonates were assessed using clinical variables (initial arterial pH, initial blood glucose, Sarnat score, electroencephalography) and spectroscopy (NAA/Cho, NAA/Cre, Cho/Cre, and lactate). Neonates were divided into two outcome groups: good/moderate and poor. Differences between the groups were assessed using chi(2) and t-test analyses. We analyzed the best predictors of outcome using discriminant analysis and calculated sensitivity, specificity, positive, and negative predictive values for each variable independently and in combination. There were significant differences between the good/moderate and poor outcome for the Sarnat score, EEG, lactate, and NAA/Cho. Spectroscopy combined with clinical variables improved sensitivity, but not specificity for predicting outcome. The presence of lactate had the best individual predictive value. Combination of the clinical with the MRS variables had the highest predictive value. Proton magnetic resonance spectroscopy done early after injury improves the ability to predict neurologic outcome at 24 months of age.

Early Prediction of Neurological Outcome after Cardiopulmonary Resuscitation: A Multimodal Approach Combining Neurobiochemical and Electrophysiological Investigations May Provide High Prognostic Certainty in Patients after Cardiac Arrest

A reliable and reproducible method for precisely predicting the neurological outcome of patients with hypoxic-ischemic encephalopathy after cardiac arrest is urgently needed in neurological intensive care units. We prospectively investigated the predictive power of serum concentrations of neuron-specific enolase (NSE) and protein S-100B (S-100B) measured on days 1, 2, 3 and 7 as well as somatosensory-evoked potentials (SEPs) recorded within 48 h and on day 7 after cardiopulmonary resuscitation (CPR) in 27 patients (14 females, 13 males; mean age 61.3 ± 17.3 years) with hypoxic-ischemic encephalopathy. During the first 7 days after CPR, median values of NSE and S-100B were increased in patients who remained unconscious after CPR compared to those patients who regained consciousness (significance up to ≤0.001). The best predictor of negative outcome was an NSE cutoff point ≧43 µg/l on day 2; this had a sensitivity of 90.9% and a specificity of 100%. Additional use of S-100B on day 2 did not increase sensitivity, but this could be markedly increased by combining NSE and S-100B on days 1, 3 and 7. SEPs showing bilateral loss of cortical responses identified patients who did not regain consciousness with a specificity of 100%.

Prediction of neurologic outcome in patients with spinal cord injury by using hyperbaric oxygen therapy

The effectiveness of hyperbaric oxygen therapy (HBO) in predicting neurological recovery in patients with spinal cord injury was evaluated. HBO has been used to treat spinal cord injury, but HBO does not appear to greatly alter the neurological outcome. This is the first report of the use of HBO as a diagnostic tool to evaluate neurological recovery after spinal cord injury. The study group consisted of 22 patients, aged 21–73 years, with spinal cord injuries. The effect of HBO was evaluated on admission and categorized as one of four grades (excellent, good, fair, or poor). The neurological status was evaluated on admission and at the time of follow-up, according to Frankel grade and the American Spinal Injury Association (ASIA) motor score. Correlations between the HBO effect and Frankel grade recovery and correlations between the HBO effect and recovery rate of the ASIA motor score were evaluated. The recovery in Frankel grade from admission to the final follow-up became better as the effectiveness of HBO increased (r=0.445; P=0.0414). The Frankel grade (r=0.036; P=0.871) and ASIA motor score (r=0.029; P=0.893) on admission did not correlate with the recovery in Frankel grade. There was a significant correlation between the HBO effect and the recovery rate of the ASIA motor score (r=0.586; P=0.0072), but this correlation was weaker than that for the ASIA motor score on admission (r=0.752; P=0.0006). We conclude that HBO can be employed to assess the status of spinal cord function recovery after spinal cord injury.

Antegrade selective cerebral perfusion during surgery of the thoracic aorta: risk analysis.

To determine independent predictors of neurologic outcome and hospital mortality after surgery of the thoracic aorta using moderate hypothermic circulatory arrest and antegrade selective cerebral perfusion. Between November 1996 and June 2000, 96 consecutive patients (69 men, 27 women; mean age 63+/-10 years) underwent operations on the thoracic aorta with the aid of moderate hypothermic circulatory arrest and antegrade selective cerebral perfusion. Sixty-four patients were operated on electively (66.7%), 32 emergently (33.3%). Indications for surgery were: type A acute dissection in 30 patients (31.3%), chronic aneurysm in 66 (68.8%). Seventeen patients (17.7%) had undergone previous aortic/cardiac surgical procedures. The mean selective cerebral perfusion time was 52.2+/-31.9 min (range, 18-220 min). Preoperative, intraoperative, and postoperative factors were analyzed by univariate and multivariate analysis to identify predictors of hospital mortality and neurologic outcome. There were no operative deaths; the hospital mortality rate was 11.5% (11/96). Stepwise logistic regression revealed preoperative renal dysfunction (P=0.021), type A acute dissection (P=0.053), coronary artery bypass grafting (P=0.058), post-operative pulmonary complications (P=0.000) and repeat thoracotomy for bleeding (P=0.027) as independent predictors of hospital mortality. One patient sustained a permanent neurologic deficit (1%). Transient neurologic deficit occurred in eight patients (8.3%). Coronary artery bypass grafting (P=0.013), and postoperative cardiac complications (P=0.049) were statistically associated with an increased risk of any (transient and permanent) neurologic dysfunction on univariate analysis. Stepwise logistic regression indicated coronary artery bypass grafting as independent factor for any neurologic dysfunction. This study confirmed that selective cerebral perfusion is an effective method of cerebral protection allowing complex thoracic aorta operations to be performed with low risk of hospital mortality and adverse neurologic outcome. We didn't find that the duration of selective cerebral perfusion time influence hospital mortality and any neurologic deficit.

Diagnostic and therapeutic management of spinal arachnoid cysts.

The wide variety of intraspinal cystic lesions necessitates different elaborate diagnostic procedures to choose the right therapeutic management in symptomatic patients. Based on the case reports of seven patients with symptomatic spinal arachnoid cysts we discuss the aetiology, diagnostic procedures and therapeutic management of extra- and intradural spinal cysts. All patients underwent MRI, Myelography and CT-Myelography during diagnostic evaluation. During surgery the cyst was resected and the communication between the cyst and the subarachnoid space was closed. Two patients were identified with intradural, five with extradural spinal arachnoid cysts. Postoperative outcome was favourable in those patients without preoperative cord damage. MRI is the diagnostic procedure of first choice because of its potential to demonstrate the exact localisation, extent and relationship of the arachnoid cyst to the spinal cord. Cord atrophy secondary to compression can be visualised and used for prediction of neurological outcome. Myelography and CT-Myelography (CTM) are still of diagnostic value since they might demonstrate the communication between the subarachnoid space and the cyst, which is important for surgical planning. The aim of surgical treatment is neural decompression and prevention of refilling of the cyst which is best accomplished by complete resection of the cyst and closure of the communication between cyst and subarachnoid space.

The blood leukocyte count and its prognostic significance in severe head injury

BACKGROUND Head injury is associated with increased blood levels of catecholamines and cortisol. Catecholamines release neutrophil stores, and corticosteroids cause a decrease in the egress of neutrophils from the circulation. The acute-phase response is also characterized by a leukocytosis upon admission. Therefore, it is possible that an increase in the white blood cell (WBC) count might serve as an additional diagnostic and prognostic indicator in head injury. METHODS We prospectively studied 624 patients with severe, moderate, or minor head injury who were admitted to the neurosurgical department of Asclepeion Hospital in Athens between December 1997 and March 1999. In all cases, WBC count was obtained on admission to the emergency department. Factors that might influence WBC were excluded from this study. RESULTS Patients with severe head injury had significantly higher white blood cell counts than did those with moderate or minor injury ( p < 0.001). Among the patients with severe head injury, a significant relationship was found between WBC counts and Glasgow Coma Scale score, pupillary reaction, and presence of subarachnoid hemorrhage ( p < 0.001). In the same group of patients, WBC counts were significantly higher in those with an unfavorable outcome ( p < 0.001). Multivariate analysis also showed that WBC counts were an independent predictor of outcome. CONCLUSIONS WBC counts on admission could serve as a significant parameter of severity of injury and as an additional predictor of neurological outcome in patients with severe head injury.

Prediction of neurological outcome after cardiac arrest

Prediction of neurological outcome after cardiac arrest

WS08‐06Fetal hemodynamics, hypoxia index and brain damage

ObjectiveTo estimate the value of a new vascular score, hypoxia index (HI), in prediction of functional and/or structural brain lesions caused by fetal hypoxia and to examine the relationship between this index, Doppler cerebral‐umbilical ratio (C/U) and neonatal neurosonography in growth retarded and hypoxia fetuses.Study designIn the prospective study 41 growth retarded fetuses were included from 29 to 40 weeks of gestation. Flow velocity waveforms the umbilical and middle cerebral arteries were recorded each other day, at least two weeks. The C/U ratio and HI were calculated. After the birth, obstetric parameters and ultrasound of neonatal brain were used as outcome parameters.ResultsDoppler C/U ratio &lt; 1 as well as HI &gt; 150 were associated with poor perinatal outcome. The neonatal brain damage was detected in 16 growth‐retarded and hypoxic fetuses. Hypoxia index had greater statistic significance in the prediction of neonatal brain lesions. Also, specificity and sensitivity of HI was better than the last value of C/U ratio measured before delivery.ConclusionsThe C/U ratio and HI represent the best indicators for early detecting and assessment of fetal hypoxia. Furthermore, they may also be parameters for the prediction of poor neurological outcome in pregnancies with growth retardation. So, the use of HI would represent a significant advance in prevention of hypoxic brain lesions, which are one of the most frequent causes of perinatal morbidity and mortality.

Early Prediction of Neurologic Outcome After Perinatal Depression

Evaluation is presented of whether or not a detailed neuromotor examination at 3 months of age could predict later neurologic abnormalities among term infants with perinatal depression. In a prospective cohort, infants were neurologically evaluated at 3 and 12 months. Infants were scored from 0 to 5 according to a new neuromotor scoring system. The neuromotor score at 3 months (NMS-3) was compared with the NMS at 12 months (NMS-12). Seventy-four infants were enrolled in the study; nine were lost to follow-up, and five died before reaching 1 year. Sixty infants were examined (neurologic abnormalities = 52%, normal = 48% at 1 year). The NMS-3 correlated strongly with the NMS-12 and the results of the 12-month neurologic examination. All infants with a NMS-3 of 5 had neurologic abnormalities at 1 year. Infants with neonatal seizures had a significantly increased risk of developmental abnormalities at 1 year. Eighteen infants exhibited transient abnormalities. Using a simple scoring system, the results of the early neurologic examinations correlated strongly with outcome among term infants with perinatal depression. A subgroup of infants had transient abnormalities. These findings suggest that in term high-risk infants, the 1-year neurologic outcome can be predicted at 3 months of age using these parameters.

Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest.

To examine the utility of somatosensory evoked potential (SEP) peaks and CSF creatine kinase BB isoenzyme activity (CKBB) in predicting nonawakening from coma due to cardiac arrest. Accurate predictors of neurologic outcome in patients comatose after cardiac arrest are needed to improve medical decision making. A total of 72 comatose patients had bilateral median SEPs, and of these, 52 had CSF and CKBB. Awakening was defined as following commands or having comprehensible speech. Both short (N1) and long (N3) latency SEP peaks were analyzed. Nonparametric analyses were used. For patients who had both tests, CKBB > or = 205 U/L predicted nonawakening with a sensitivity of 49% and a specificity of 100%. Bilateral absence of the N1 peak predicted nonawakening with a sensitivity of 53% and a specificity of 100%. Using CKBB > or = 205 U/L, bilaterally absent SEP N1 peaks, or both predicted nonawakening with a sensitivity of 69% and a specificity of 100%. Using CKBB > or = 205 U/L, bilaterally absent N1 peaks, bilateral N3 > or = 176 msec or absent, or some combination predicted nonawakening with a sensitivity of 78% and a specificity of 100%. The combination of an absent N1 peak and elevated CKBB performs better than either alone in predicting nonawakening after cardiac arrest. Prolonged or absent N3 latency may increase sensitivity. These results should be interpreted with caution given the small number of patients and the possibility of a self-fulfilling prophecy.

Early auditory evoked potentials in very small premature infants

Brainstem auditory evoked response (BAER) is a sensitive test of the functional integrity of the auditory pathway. Latencies and amplitudes of measured waveforms reflect maturation of this brainstem pathway and may allow a prediction for neurological outcome. BAER were measured prospectively in preterm infants with a birthweight less than 1500 g at 3 to 4 day following birth and during treatment on neonatal intensive care unit (NICU) every two weeks. Pre- and postnatal risk factors and frequency of apnea were evaluated. Outcome was scored after 1 year corrected age by neurological examination. There were no significant differences in latencies of waves between 5 children with severe asphyxia and/or IVH resulting in major neurological handicaps after 1 year. However, two of these children have bilateral abnormalities. The slope of decay of wave latencies decreased between 30 and 32 weeks gestational age, while the number of registered apnea increased. In follow up investigations during treatment on NICU there was a decrease in interpeak latencies wave V to wave III from 24/25 weeks gestational age to term infants and increase in amplitudes. Early performed BAER alone is not a good predictor for neurological outcome of preterm infants because of great interindividual variability of normal neonates and the anatomical site of cerebral lesions. The method contributes information on the brainstem maturation and may also reflect the different maturational stages of the respiratory system.

ハイリスク新生児の評価

In spite of the advancement of neonatology over the past 25 years, neonatal neurological deficits still occur. Rehabilitation professionals are required to assess neonatal neurological status and screen high risk infants. The indicators to predict developmental outcomes of the high risk infants in the neonatal periods are; 1) perinatal risk factors, 2) neurological examination, 3) general movements, and 4) neurobehavioral assessment. Severe complications of the central nervous system are risk factors for major neurologic problems. Particularly, periventricular leukomalacia and periventricular hemorrhage are significant predictors of subsequent cerebral palsy. Ultrasound brain scan, CT and MRI have helped in the non-invasive detection of brain damage in young preterm infants. Social class is related to problems in the primary school. The traditional neurological examination consists of the grading of the state, muscle tonus, posture, spontaneous movements, reflexes, and other neurological abnormalities such as neonatal seizures, repeated apnea, oral-motor dysfunction, or high-pitched cry. Qualitative assessment of general movement has been shown to be a good predictor of neurologic outcome in high risk preterm infants. Brazelton Neonatal Behavioral Assessment Scale combines both behavioral and neurological approaches. The following points should be kept in mind when assessing infants in the neonatal period. 1) To predict subsequent disabilities, we must consider findings of various assessment methods comprehensively. 2) The assessment should be designed to be easy, reliable, and non-invasive. 3) Children must be followed up at least until they enter primary schools.

Early prediction of neurologic outcome after perinatal depression

Evaluation is presented of whether or not a detailed neuromotor examination at 3 months of age could predict later neurologic abnormalities among term infants with perinatal depression. In a prospective cohort, infants were neurologically evaluated at 3 and 12 months. Infants were scored from 0 to 5 according to a new neuromotor scoring system. The neuromotor score at 3 months (NMS-3) was compared with the NMS at 12 months (NMS-12). Seventy-four infants were enrolled in the study; nine were lost to follow-up, and five died before reaching 1 year. Sixty infants were examined (neurologic abnormalities = 52%, normal = 48% at 1 year). The NMS-3 correlated strongly with the NMS-12 and the results of the 12-month neurologic examination. All infants with a NMS-3 of 5 had neurologic abnormalities at 1 year. Infants with neonatal seizures had a significantly increased risk of developmental abnormalities at 1 year. Eighteen infants exhibited transient abnormalities. Using a simple scoring system, the results of the early neurologic examinations correlated strongly with outcome among term infants with perinatal depression. A subgroup of infants had transient abnormalities. These findings suggest that in term high-risk infants, the 1-year neurologic outcome can be predicted at 3 months of age using these parameters.

Prediction of neurological outcome after cardiopulmonary resuscitation

In 231 patients with circulatory arrest of primary cardiovascular or pulmonary aetiology guidelines were established for predicting neurological outcome within the first year after cardiopulmonary resuscitation. Outcome measures were brain death, persistent unconsciousness, persistent disability after awakening and complete recovery. A total of 116 patients remained unconscious while 115 regained consciousness. Brain stem areflexia with apnoea (brain death) was demonstrated in 40 patients. No other finding per se could predict a specific outcome. The time for recovery of individual neurological functions seemed to be the key to prognostication. Testing the caloric vestibular reflex or stereotypic reactivity thus differentiated patients regaining consciousness from those remaining unconscious, with positive predictive values of 0.79 and 0.77 at 1 h and negative values of 1.0 and 0.97 at 24 h as compared with 50/50 prior odds. The presence of speech at 24 h or the ability to cope with personal necessities at 72 h predicted complete recovery with positive predictive values of 0.91 and 0.92 as compared with prior odds of 0.17, whereas, the negative predictive values never exceeded prior odds of 0.83.

Prediction of neurological outcome after birth asphyxia from early continuous two-channel electroencephalography.

To determine whether two-channel continuous electroencephalography (EEG) applied within 12 h of birth can predict the severity of neurological complications and neurodevelopmental outcome following birth asphyxia. A continuous two-channel EEG was performed within 12 h of birth in 22 infants suspected of having suffered birth asphyxia and 11 healthy control infants (22 infants at a general and 11 at a specialist paediatric unit). Criteria to categorise normal and abnormal EEG records were defined and compared with the severity of hypoxic/ischaemic encephalopathy (HIE) and with neurodevelopmental outcome, assessed at or after 12 months of age. EEG recordings were commenced at a median (range) of 2 h 50 min (1 h 45 min to 12 h) after birth. Technically satisfactory recordings were obtained in all but one infant. All control infants remained asymptomatic and had a normal EEG with discernible sleep/awake periods. 12 h after birth the EEG was normal in all 12 infants suspected of asphyxia who remained well or developed grade 1 HIE and was abnormal in six of nine infants with grade II or III HIE. Fifteen of 16 infants suspected of asphyxia with a normal neurodevelopmental outcome had a normal EEG at 12 h; transient abnormalities lasting not more than 8 h had been detected in three of these infants. All five infants who died or developed neurodevelopmental abnormalities had an abnormal EEG. At 12 h of age the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratio for predicting severe (grade II or III) HIE were: 67, 100, 100, 80% and infinity and for subsequent death or neurodevelopmental impairments: 100, 94, 83, 100 and 16%, respectively. Assessment of the EEG before 12 h of age altered prognostic accuracy: 4 h after birth the sensitivity, specificity, positive and negative predictive values and the likelihood ratio for poor neurodevelopmental outcome were 100, 71, 33%, 100 and 3.7%, respectively (16 infants). Continuous two-channel EEG is an accurate tool for assessing the severity of neurological insult soon after birth asphyxia.