title: Early predictors of short term neurodevelopmental outcome in asphyxiated cooled infants. A combined brain amplitude integrated electroencephalography and near infrared spectroscopy study.
abstract: BACKGROUND
  Brain Cooling (BC) represents the elective treatment in asphyxiated newborns. Amplitude Integrated Electroencephalography (aEEG) and Near Infrared Spectroscopy (NIRS) monitoring may help to evaluate changes in cerebral electrical activity and cerebral hemodynamics during hypothermia.
  
  
  OBJECTIVE
  To evaluate the prognostic value of aEEG time course and NIRS data in asphyxiated cooled infants.
  
  
  METHODS
  Twelve term neonates admitted to our NICU with moderate-severe Hypoxic-Ischemic Encephalopathy (HIE) underwent selective BC. aEEG and NIRS monitoring were started as soon as possible and maintained during the whole hypothermic treatment. Follow-up was scheduled at regular intervals; adverse outcome was defined as death, cerebral palsy (CP) or global quotient <88.7 at Griffiths' Scale.
  
  
  RESULTS
  2/12 Infants died, 2 developed CP, 1 was normal at 6 months of age and then lost at follow-up and 7 showed a normal outcome at least at 1 year of age. The aEEG background pattern at 24 h of life was abnormal in 10 newborns; only 4 of them developed an adverse outcome, whereas the 2 infants with a normal aEEG developed normally. In infants with adverse outcome NIRS showed a higher Tissue Oxygenation Index (TOI) than those with normal outcome (80.0±10.5% vs 66.9±7.0%, p=0.057; 79.7±9.4% vs 67.1±7.9%, p=0.034; 80.2±8.8% vs 71.6±5.9%, p=0.069 at 6, 12 and 24 h of life, respectively).
  
  
  CONCLUSIONS
  The aEEG background pattern at 24h of life loses its positive predictive value after BC implementation; TOI could be useful to predict early on infants that may benefit from other innovative therapies.
authors.affiliation: Neonatology Unit, Department of Woman, Child and Adolescent Health, Sant'Orsola Hospital, University of Bologna, Bologna, Italy. Gina.Ancora@auslrn.net
authors.forename: Gina
authors.initials: G
authors.lastname: Ancora
authors.forename: Eugenia
authors.initials: E
authors.lastname: Maranella
authors.forename: Sara
authors.initials: S
authors.lastname: Grandi
authors.forename: Francesca
authors.initials: F
authors.lastname: Sbravati
authors.forename: Elena
authors.initials: E
authors.lastname: Coccolini
authors.forename: Silvia
authors.initials: S
authors.lastname: Savini
authors.forename: Giacomo
authors.initials: G
authors.lastname: Faldella
mesh_terms: D001238:Asphyxia Neonatorum / Q000503:physiopathology / Q000628:therapy*; D001921:Brain / Q000503:physiopathology*; D004569:Electroencephalography / Q000379:methods; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000503:physiopathology / Q000628:therapy*; D007231:Infant, Newborn; D011379:Prognosis; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D016896:Treatment Outcome