Should amplitude-integrated electroencephalography be used to identify infants suitable for hypothermic neuroprotection?
OBJECTIVE
Amplitude-integrated electroencephalography (aEEG) has been used adjunctively to identify infants suitable for hypothermic neuroprotection following severe intrapartum asphyxia. To determine whether an early aEEG predicts short-term adverse outcome in infants with significant hypoxic-ischemic encephalopathy (HIE) evaluated for hypothermic neuroprotection.


METHODS
The aEEG recordings were obtained within 6 h of birth in infants >or=36 weeks' gestational age during evaluation for possible selective head or whole-body cooling. Recordings were subsequently re-evaluated for both background pattern and voltage abnormalities by a certified reader masked to clinical history and brain-oriented interventions. All infants with moderate or severe HIE evaluated for hypothermic neuroprotection also underwent magnetic resonance imaging (MRI) of the brain at a median postnatal age of 7 days. The predictive value using the aEEG for determining short-term dichotomous outcomes, defined as early death related to HIE, or a characteristic pattern of abnormalities consistent with hypoxic-ischemic injury on the MRI brain scans was assessed.


RESULTS
Fifty-four infants with moderate or severe HIE were evaluated with aEEG for hypothermic neuroprotection; 34 infants received selective head cooling, 12 infants underwent total body cooling and 8 infants were not cooled. Outcome data, available for 46 of the 54 infants, revealed a poor correlation between the early aEEG and short-term adverse outcomes, with a sensitivity of 54.8% and negative predictive value (NPV) of only 44%.


CONCLUSIONS
Because of the poor NPV of an early aEEG for a short-term adverse outcome, its use as an 'additional selection criterion' for hypothermic neuroprotection may not be appropriate.
Sarkar
S
S
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, MI 48109, USA. subratas@med.umich.edu
Barks
J D
JD
Donn
S M
SM
D001238:Asphyxia Neonatorum / Q000150:complications; D001921:Brain / Q000473:pathology; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000209:etiology; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D018579:Patient Selection; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity