An Evaluation of Cerebral and Systemic Predictors of 18-Month Outcomes for Neonates With Hypoxic Ischemic Encephalopathy.
Amplitude-integrated EEG (aEEG) is a commonly used predictor of outcome after hypoxic ischemic encephalopathy. Cerebral and systemic near-infrared spectroscopy and acute kidney injury might also have prognostic value. The authors monitored neonates with aEEG, cerebral and systemic near-infrared spectroscopy during therapeutic hypothermia, assigned an acute kidney injury stage, and measured neurodevelopmental outcome. For 18 infants, cerebral near-infrared spectroscopy variables did not differentiate between those with favorable (n = 13) versus adverse (death or moderate-severe disability; n = 5) 18-month outcomes. However, systemic rSO2 variability was higher during hours 48-72 of cooling among those with favorable outcomes (.02 < P < .03). Mean aEEG amplitude during hours 24 to 48 of cooling was higher among those with good outcomes (.027 < P < .032). The aEEG lower margin was also higher during hours 12 to 48 for those with good outcomes (.014 < P < .035). Acute kidney injury did not predict outcome (P > .05). aEEG is a useful prognostic tool for outcomes after neonatal hypoxic ischemic encephalopathy, but the role of near-infrared spectroscopy in the hypothermia-treated population remains uncertain.
Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI, USA shellhaa@med.umich.edu.
Renée A
RA
Shellhaas
Wayne State University School of Medicine, Detroit, MI, USA.
Juhi S
JS
Kushwaha
Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA.
Melissa A
MA
Plegue
Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
David T
DT
Selewski
Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
John D E
JD
Barks
D001921:Brain / Q000503:physiopathology*; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D010865:Pilot Projects; D011379:Prognosis; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
acute kidney injury; amplitude-integrated EEG; developmental outcome; hypoxic-ischemic encephalopathy; near-infrared spectroscopy