title: Delayed onset of sleep-wake cycling with favorable outcome in hypothermic-treated neonates with encephalopathy.
abstract: OBJECTIVE
  To determine whether hypothermia modulates acquisition of sleep-wake cycling in term neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE) and the relationship to outcome.
  
  
  METHODS
  Twenty-nine term infants with moderate to severe HIE treated with selective head cooling were evaluated. All were monitored with amplitude-integrated electroencephalography during and video electroencephalography immediately after hypothermia for ≥72 hours. Electroencephalograpic data were analyzed for background and sleep-wake cycling. Abnormal outcome included death or severe global neurodevelopmental disability ≥18 months.
  
  
  RESULTS
  Acquisition of sleep-wake cycling was noted in nine infants by 72 hours, in 13 by 96 hours, 19 by 120 hours, and 22 by 144 hours. Presence of sleep-wake cycling was associated with normal outcome, that is, 14 of 22 (64%), versus abnormal outcome, that is, none of seven without sleep-wake cycling (P = .006). The presence of sleep-wake cycling by 120 hours had a positive predictive value of 68% and negative predictive value of 90%. Magnetic resonance imaging abnormalities were related to onset of sleep-wake cycling.
  
  
  CONCLUSIONS
  Although onset of sleep-wake cycling is markedly delayed in term neonates with moderate to severe HIE treated with hypothermia, approximately 65% with acquisition of cycling have a normal outcome. Sleep-wake cycling is an important additional tool for assessing recovery in term infants with moderate to severe HIE treated with hypothermia.
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10021, USA.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Takenouchi
authors.forename: Elayna O
authors.initials: EO
authors.lastname: Rubens
authors.forename: Vivien L
authors.initials: VL
authors.lastname: Yap
authors.forename: Gail
authors.initials: G
authors.lastname: Ross
authors.forename: Murray
authors.initials: M
authors.lastname: Engel
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Perlman
mesh_terms: D001921:Brain / Q000503:physiopathology*; D002940:Circadian Rhythm / Q000502:physiology*; D004569:Electroencephalography; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D011379:Prognosis; D012189:Retrospective Studies; D012890:Sleep / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology