title: Early clinical predictors of a severely abnormal amplitude-integrated electroencephalogram at 48 hours in cooled neonates.
abstract: OBJECTIVE
  There is a need to identify infants with hypoxic ischaemic encephalopathy who have a poor outcome despite therapeutic hypothermia. A severely abnormal amplitude-integrated electroencephalogram at 48 h predicts death or disability. Our aim was to determine whether clinical assessment at age 3-5 h predicts a severely abnormal amplitude-integrated electroencephalogram at 48 h or death in cooled infants.
  
  
  METHODS
  Forty-one cooled infants, ≥36 weeks' gestation, with moderate-to-severe hypoxic ischaemic encephalopathy, were prospectively enrolled. Infants who were moribund, had congenital conditions associated with encephalopathy or had severe cardio-respiratory instability were excluded. The predictive abilities of the Thompson encephalopathy score and individual signs at age 3-5 h were assessed.
  
  
  RESULTS
  All infants with a Thompson score ≥16 at 3-5 h had a severely abnormal amplitude-integrated electroencephalogram at 6 h and an abnormal short-term outcome. At 48 h, 75% had a severely abnormal aEEG or died vs. 18% with a score <16 (p = 0.004). Multivariate analysis did not find a significant independent association with any of the individual signs.
  
  
  CONCLUSIONS
  The Thompson score could be useful to identify infants who will have a poor outcome despite cooling. A score ≥16 should be validated as a prespecified variable in prospective studies.
authors.affiliation: School of Child and Adolescent Health, Department of Paediatrics, University of Cape Town, Cape Town, South Africa. alan.horn@uct.ac.za
authors.forename: Alan R
authors.initials: AR
authors.lastname: Horn
authors.forename: George H
authors.initials: GH
authors.lastname: Swingler
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
authors.forename: Lucy L
authors.initials: LL
authors.lastname: Linley
authors.forename: Manigandan
authors.initials: M
authors.lastname: Chandrasekaran
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Robertson
mesh_terms: D001034:Apgar Score; D015331:Cohort Studies; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D005865:Gestational Age; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013019:South Africa; D016019:Survival Analysis; D013997:Time Factors