title: Therapeutic hypothermia in neonatal hypoxic ischemic encephalopathy: electrographic seizures and magnetic resonance imaging evidence of injury.
abstract: OBJECTIVE
  To evaluate the electrographic seizure burden in neonates with hypoxic ischemic encephalopathy (HIE) treated with or without therapeutic hypothermia and stratified results by severity of HIE and severity of injury as assessed by magnetic resonance imaging (MRI).
  
  
  METHODS
  Between 2007 and 2011, video-electroencephalography (EEG) monitoring was initiated in neonates with moderate to severe HIE. Seizure burden (in seconds) was calculated, and brain MRI scans were quantitatively scored. Data were analyzed by ANOVA, the Student t test, and the χ(2) test.
  
  
  RESULTS
  Sixty-nine neonates with moderate or severe HIE were prospectively enrolled, including 51 who received therapeutic hypothermia and 18 who did not. The mean duration of video-EEG monitoring was longer in the therapeutic hypothermia group (72 ± 34 hours vs 48 ± 34 hours; P = .01). The therapeutic hypothermia group had a lower electrographic seizure burden (log units) after controlling for injury, as assessed by MRI (2.9 ± 0.6 vs 6.2 ± 0.9; P = .003). A reduction in seizure burden was seen in neonates with moderate HIE (P = .0001), but not in those with severe HIE (P = .80). Among neonates with injury assessed by MRI, seizure burden was lower in those with mild (P = .0004) and moderate (P = .02) injury, but not in those with severe injury (P = .90).
  
  
  CONCLUSIONS
  Therapeutic hypothermia was associated with reduced electrographic seizure burden in neonatal HIE. This effect was detected on video-EEG in infants with moderate HIE, but not in those with severe HIE. When stratified by injury as assessed by MRI, therapeutic hypothermia was associated with a reduced seizure burden in infants with mild and moderate injury, but not in those with severe injury.
authors: Department of Pediatrics, Washington University in St Louis, St Louis, MO, USA. psrinivasakumar@chmca.org
authors: Preethi
authors: P
authors: Srinivasakumar
authors: John
authors: J
authors: Zempel
authors: Michael
authors: M
authors: Wallendorf
authors: Russell
authors: R
authors: Lawrence
authors: Terrie
authors: T
authors: Inder
authors: Amit
authors: A
authors: Mathur
mesh_terms: D001927:Brain Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012640:Seizures / Q000209:etiology / Q000503:physiopathology; D012720:Severity of Illness Index; D014741:Video Recording
keywords: Amplitude-integrated electroencephalography; EEG; Electroencephalography; HIE; Hypoxic ischemic encephalopathy; MRI; Magnetic resonance imaging; aEEG