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


METHODS
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.


RESULTS
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).


CONCLUSIONS
Continuous two-channel EEG is an accurate tool for assessing the severity of neurological insult soon after birth asphyxia.
Azzopardi
D
D
Department of Paediatrics and Neonatal Medicine, Imperial College School of Medicine, Hammersmith Hospital, London, UK. dazzopar@rpms.ac.uk
Guarino
I
I
Brayshaw
C
C
Cowan
F
F
Price-Williams
D
D
Edwards
A D
AD
Acolet
D
D
D001238:Asphyxia Neonatorum / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D002545:Brain Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D004569:Electroencephalography / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors