title: Amplitude-integrated electroencephalography coupled with an early neurologic examination enhances prediction of term infants at risk for persistent encephalopathy.
abstract: OBJECTIVE
  The objectives of this study were to determine, first, whether an early neurologic examination could predict a persistent abnormal neonatal neurologic state comparable to the amplitude-integrated electroencephalography (a-EEG) and, second, whether a combination of the 2 methods would further enhance early identification of high-risk infants.
  
  
  METHODS
  Fifty term infants were enrolled prospectively when they had evidence of intrapartum distress, Apgar score <or=5 at 5 minutes, or cord arterial pH <or=7.00 and were admitted to intensive care. Each enrolled infant underwent an early neurologic examination using a modified Sarnat staging system (stages 2 and 3 were regarded as abnormal) and a blinded simultaneous a-EEG measurement. Predictive values were calculated for a short-term abnormal outcome defined as persistent moderate to severe encephalopathy beyond 5 days.
  
  
  RESULTS
  An abnormal short-term outcome was present in 14 (28%) of 50 infants. The neurologic examination was performed at 5 +/- 3 hours after delivery. A short-term abnormal outcome occurred in 9 (53%) of 17 infants with initial stage 2 and in both infants with initial stage 3 encephalopathy. In addition, 13 infants manifested features of both stage 1s and 2 and post hoc were classified (S1-2). Three of the latter infants (23%) developed an abnormal short-term outcome. The a-EEG was abnormal in 15 (30%) infants, 11 (73%) of whom developed an abnormal outcome. An abnormal a-EEG was more specific (89% vs 78%), had a greater positive predictive value (73% vs 58%), and had similar sensitivity (79% vs 78%) and negative predictive value (90% vs 91%) when compared with an abnormal early neurologic examination. A combination of abnormalities had the highest specificity (94%) and positive predictive value (85%).
  
  
  CONCLUSIONS
  The combination of the a-EEG and the neurologic examination shortly after birth enhances the ability to identify high-risk infants and limits the number of infants who would be falsely identified compared with either evaluation alone.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9063, USA.
authors.forename: Lina F
authors.initials: LF
authors.lastname: Shalak
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: Sithembiso C
authors.initials: SC
authors.lastname: Velaphi
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Perlman
mesh_terms: D001034:Apgar Score; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D020208:Brain Injury, Chronic / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D002658:Developmental Disabilities / Q000209:etiology; D004569:Electroencephalography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008279:Magnetic Resonance Imaging; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D009460:Neurologic Examination / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors