Response to Correspondence on “Amplitude-Integrated EEG Is Useful in Predicting Neurodevelopmental Outcome in Full-Term Infants with Hypoxic–Ischemic Encephalopathy: A Meta-Analysis”

Background: Among term infants, hypoxic-ischemic encephalopathy due to acute perinatal asphyxia remains an important cause of neurodevelopmental deficits in childhood. Treatment is currently limited to supportive intensive care, without any specific brain-oriented therapy. Objective: To determine whether the risk of death or moderate/severe neurodevelopmental impairment in term infants with hypoxic-ischemic encephalopathy increases with relatively high skin or rectal temperature between 12 and 72 hours of birth. Materials and Methods: This was a prospective observational study. Asphyxiated newborns who came within 12 hours of birth were enrolled in this study. Both axillary and rectal temperature were recorded 6 hourly for 72 hours and each infant`s temperature for each site were rank ordered. Then mean of all axillary and rectal temperatures of each neonate was calculated. Outcomes were related to temperatures in logistic regression analyses for the elevated/relatively high temperatures and normal/low temperatures group, with adjustment of the level of encephalopathy and gender. Results: The mean axillary temperature was 36.07 ± 6.10C and in 25.71%, 11.92% and 6.32% cases axillary temperatures were >370C, >37.50C and >380C respectively. The mean rectal temperature was 36.8 ± 60C, and in 43.53%, 30.02% and 19.97% cases rectal temperatures were >370C, >37.50C and >380C respectively. Mean ambient temperature was 26.170C. There was significant correlation between axillary and rectal temperatures (r=0.889). For elevated temperature, the odds of death or moderate to severe impairment increased 8.9-fold (CI 0.906–88.18) and the odds of death alone increased 4.6-fold (CI 0.373–56.83). The odds of impairment increased 1.84-fold (CI 0.45– 7.50). Conclusion: Relatively high temperature during usual care after hypoxic-ischemia in term neonates was associated with adverse neurodevelopmental outcomes. J Enam Med Col 2019; 9(3): 160-165

Download Full-text

Neurodevelopmental outcome of term infants with perinatal asphyxia with hypoxic ischemic encephalopathy stage II

Brain and Development ◽

10.1016/j.braindev.2016.09.005 ◽

2017 ◽

Vol 39 (2) ◽

pp. 107-111 ◽

Cited By ~ 16

Author(s):

Sudhir Adhikari ◽

Kalipatnam Seshagiri Rao

Keyword(s):

Perinatal Asphyxia ◽

Neurodevelopmental Outcome ◽

Stage Ii ◽

Hypoxic Ischemic Encephalopathy ◽

Term Infants ◽

Ischemic Encephalopathy

Download Full-text

Early MR detection of cortical and subcortical hypoxic-ischemic encephalopathy in full-term-infants

Pediatric Radiology ◽

10.1007/bf02012738 ◽

1994 ◽

Vol 24 (8) ◽

pp. 581-584 ◽

Cited By ~ 9

Author(s):

C. Christophe ◽

A. Clercx ◽

D. Blum ◽

D. Hasaerts ◽

C. Segebarth ◽

...

Keyword(s):

Full Term ◽

Hypoxic Ischemic Encephalopathy ◽

Term Infants ◽

Ischemic Encephalopathy

Download Full-text

Urinary S100B protein measurements: A tool for the early identification of hypoxic-ischemic encephalopathy in asphyxiated full-term infants

Critical Care Medicine ◽

10.1097/01.ccm.0000104116.91462.cd ◽

2004 ◽

Vol 32 (1) ◽

pp. 131-136 ◽

Cited By ~ 62

Author(s):

Diego Gazzolo ◽

Emanuela Marinoni ◽

Romolo Di Iorio ◽

Matteo Bruschettini ◽

Maria Kornacka ◽

...

Keyword(s):

Early Identification ◽

Full Term ◽

Hypoxic Ischemic Encephalopathy ◽

S100b Protein ◽

Term Infants ◽

Ischemic Encephalopathy

Download Full-text

MR-patterns of brain’s hypoxic-ischemic lesions in term newborns

Pediatrician (St Petersburg) ◽

10.17816/ped8686-93 ◽

2017 ◽

Vol 8 (6) ◽

pp. 86-93

Author(s):

Tat'yana V. Melashenko ◽

Aleksandr V. Pozdnyakov ◽

Viktor S. Lvov ◽

Dmitry O. Ivanov

Keyword(s):

Brain Damage ◽

Neurological Disorders ◽

Cortical Neurons ◽

Developed Countries ◽

Full Term ◽

Hypoxic Ischemic Encephalopathy ◽

Term Infants ◽

Basal Nuclei ◽

Term Newborns ◽

Ischemic Encephalopathy

Perinatal hypoxic-ischemic encephalopathy (HIE) remains a major cause of neonatal mortality and development of severe neurological disorders that determine the quality of life of these children. In developed countries, the frequency of detection of hypoxic-ischemic encephalopathy (HIE) among full-term newborns is 1-6 per 1.000 live births. In our country, hypoxic-ischemic brain damage is observed in 15-30% of full-term newborns. The term HIE is a clinical diagnosis combining neurological disorders and biochemical changes caused by perinatal HI (hypoxiа-ischemia). The pattern of acute brain damage depends on the degree of cerebral maturity, the severity and duration of hypoxiа-ischemia. The most vulnerable regions are the structures of the brain with high level of metabolism. Such structures in term infants include cortical neurons and neurons of basal nuclei, a subcortical white matter. MRI allows to diagnose brain lesions in term infants in the acute period of HIE. Safety, non-invasiveness and large diagnostic capabilities of MRI allow this method to be considered the gold standard of neuroimaging in neonatology. In this review we described the main MRI patterns of brain injury in term neonates following HIE.

Download Full-text

Mild Hypoxic–Ischemic Encephalopathy: Can Neurophysiological Monitoring Predict Unfavorable Neurological Outcome? A Systematic Review and Meta-analysis

American Journal of Perinatology ◽

10.1055/s-0041-1736593 ◽

2021 ◽

Author(s):

Raffaele Falsaperla ◽

Sarah Sciuto ◽

Daniela Gioè ◽

Laura Sciuto ◽

Francesco Pisani ◽

...

Keyword(s):

Systematic Review ◽

Neurological Outcome ◽

Meta Analysis ◽

Neurodevelopmental Outcome ◽

Hypoxic Ischemic Encephalopathy ◽

Neurological Involvement ◽

Neurophysiological Monitoring ◽

Neonatal Deaths ◽

Ischemic Encephalopathy

Objective Hypoxic–ischemic encephalopathy (HIE) is the second cause of neonatal deaths and one of the main conditions responsible for long-term neurological disability. Contrary to past belief, children with mild HIE can also experience long-term neurological sequelae. The aim of this systematic review is to determine the predictive value of long-term neurological outcome of (electroencephalogram) EEG/amplitude-integrated electroencephalogram (aEEG) in children who complained mild HIE. Study Design From a first search on PubMed, Google Scholar, and clinicalTrials.gov databases, only five articles were considered suitable for this study review. A statistical meta-analysis with the evaluation of odds ratio was performed on three of these studies. Results No correlation was found between the characteristics of the electrical activity of the brain obtained through EEG/aEEG in infants with mild HIE and subsequent neurological involvement. Conclusion EEG/aEEG monitoring in infants with mild HIE cannot be considered a useful tool in predicting their neurodevelopmental outcome, and its use for this purpose is reported as barely reliable. Key Points

Download Full-text

Predictors of Outcomes in Hypoxic-Ischemic Encephalopathy following Hypothermia: A Meta-Analysis

Neonatology ◽

10.1159/000505519 ◽

2020 ◽

Vol 117 (4) ◽

pp. 411-427 ◽

Cited By ~ 2

Author(s):

Sabine Ouwehand ◽

Lisanne C.A. Smidt ◽

Jeroen Dudink ◽

Manon J.N.L. Benders ◽

Linda S. de Vries ◽

...

Keyword(s):

Magnetic Resonance ◽

Therapeutic Hypothermia ◽

Meta Analysis ◽

Neurodevelopmental Outcome ◽

Hypoxic Ischemic Encephalopathy ◽

Resonance Spectroscopy ◽

Test Accuracy ◽

Neurodevelopmental Outcomes ◽

Posterior Limb ◽

Ischemic Encephalopathy

Introduction: Prediction of neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy remains an important challenge. Various studies have shown that the predictive ability of different modalities changed after the introduction of therapeutic hypothermia. This paper reviews the diagnostic test accuracy of the different modalities that are being used to predict neurodevelopmental outcomes following therapeutic hypothermia. Methods: A systematic literature search was performed using Embase and PubMed. Two reviewers independently included eligible studies and extracted data. The quality of the studies was assessed using the Quality in Prognosis Studies Tool. Meta-analyses were performed where possible. Results: Forty-seven articles and 3 conference abstracts were included, reporting on 3,072infants of whom 39% died or had an adverse neurodevelopmental outcome. A meta-analysis could be performed using 37 articles on (amplitude-integrated) electroencephalography (EEG), conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and proton magnetic resonance spectroscopy (1H-MRS). Amplitude-integrated EEG (aEEG) at 24 and 72 h showed similar high diagnostic OR, while aEEG at 6 h and EEG performed less, both due to a low specificity. For MRI, most studies reported scoring systems in which early (<8 days) MRI performed better than late (≥8 days) MRI. Injury to the posterior limb of the internal capsule on MRI or to the thalami on DWI were strong individual predictors, as was an increased lactate/N-acetylaspartate peak on 1H-MRS. Conclusions: In the era of therapeutic hypothermia, the different modalities remain good predictors of neurodevelopmental outcome. However, timing should be taken into account. aEEG may initially be false positive and gets more reliable after 24 h. In contrast, MRI should be used during the first week, as its predictive value decreases afterwards.

Download Full-text

Electroencephalogram abnormalities in full term infants with history of severe asphyxia

Paediatrica Indonesiana ◽

10.14238/pi55.6.2015.297-301 ◽

2016 ◽

Vol 55 (6) ◽

pp. 297

Author(s):

Susanti Halim ◽

I Gusti Nyoman Made Suwarba ◽

I Made Kardana

Keyword(s):

Cross Sectional Study ◽

Full Term ◽

Hypoxic Ischemic Encephalopathy ◽

Chi Square ◽

Term Infants ◽

Cross Sectional ◽

Term Neonates ◽

History Of ◽

Abnormal Eegs ◽

Ischemic Encephalopathy

ingtool used to determine developmental and electrical problemsin the brain. A history of severe asphyxia is a risk factor for thesebrain problems in infants.Objective To evaluate the prevalence of abnormal EEGs infull term neonates and to assess for an association with severeasphyxia, hypoxic ischemic encephalopathy (HIE), and spontaneousdelivery.Methods This cross-sectional study was conducted at thePediatric Outpatient Department of Sanglah Hospital, Denpasar,from November 2013 to January 2014. Subjects were fullterminfants aged 1 month who were delivered and/or hospitalized atSanglah Hospital. All subjects underwent EEG. The EEGs wereinterpreted by a pediatric neurology consultant, twice, with aweek interval between readings. Clinical data were obtainedfrom medical records. Association between abnormal ECG andsevere asphyxia were analyzed by Chi-square and multivariablelogistic analyses.Results Of 55 subjects, 27 had a history of severe asphyxia and 28were vigorous babies. Forty percent (22/55) of subjects had abnormalEEG findings, 19/22 of these subjects having history of severeasphyxia, 15/22 had history of hypoxic-ischemic encephalopathy(HIE), and 20/22 were delievered vaginally. There were strongcorrelations between the prevalence of abnormal EEG and historyof severe asphyxia, HIE, and spontaneous delivery.Conclusion Prevalence of abnormal EEG among full-term neonatesreferred to neurology/growth development clinic is around40%, with most of them having a history of severe asphyxia. AbnormalEEG is significantly associated to severe asphyxia, HIE, andspontaneous delivery.

Download Full-text