title: Prediction of Neonatal Seizures in Hypoxic-Ischemic Encephalopathy Using Electroencephalograph Power Analyses.
abstract: The severity of the initial encephalopathy in neonatal hypoxic-ischemic encephalopathy correlates with seizure burden. Early electroencephalograph (EEG) background activity reflects the severity of encephalopathy. Thus, we hypothesized that early EEG background would be predictive of subsequent seizures in neonatal hypoxic-ischemic encephalopathy.
  
  
  
  This study included infants undergoing therapeutic hypothermia at St. Louis Children's Hospital between January 2009 and April 2013. Two pediatric epilepsy specialists independently characterized EEG background qualitatively using amplitude-integrated EEG trends. Total EEG power in the 1-20 Hz frequency band was calculated for quantitative EEG background assessment. Seizures were identified on conventional full montage EEG. Statistical analysis was performed using logistic regression.
  
  
  
  Seventy-eight of the 93 eligible infants had artifact-free EEG data; 23 of 78 infants (29%) developed seizures, and of these, 11 developed status epilepticus. The best predictors of subsequent seizures during the first hour of EEG recording were a flat tracing pattern on amplitude-integrated EEG (sensitivity 26%, specificity 98%, likelihood ratio 13, positive predictive value 85%) and the total EEG power less than 10 μV2(sensitivity 52%, specificity 98%, likelihood ratio 30, positive predictive value 92%).
  
  
  
  Early EEG biomarkers predict subsequent seizures in infants with hypoxic-ischemic encephalopathy. Compared with the qualitative amplitude-integrated EEG background, total EEG power improves our ability to identify high-risk infants from the first hour of EEG recording. Infants with a total EEG power of less than 10 μV2have a 90% risk of subsequent seizures. Quantitative EEG measures could stratify cohorts while evaluating novel neuroprotective strategies in neonatal hypoxic-ischemic encephalopathy.
authors.affiliation: Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri. Electronic address: jains@neuro.wustl.edu.
authors.forename: Siddharth V
authors.initials: SV
authors.lastname: Jain
authors.affiliation: Division of Newborn Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Amit
authors.initials: A
authors.lastname: Mathur
authors.affiliation: MEDNAX Health Solutions Partner, Pediatrix Medical Group of North Carolina, Charlotte, North Carolina.
authors.forename: Preethi
authors.initials: P
authors.lastname: Srinivasakumar
authors.affiliation: Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Michael
authors.initials: M
authors.lastname: Wallendorf
authors.affiliation: Department of Radiology, Washington University School of Medicine, St. Louis, Missouri; Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Missouri; Department of Physics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Culver
authors.affiliation: Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: John M
authors.initials: JM
authors.lastname: Zempel
mesh_terms: D004569:Electroencephalography; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D007223:Infant; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D012372:ROC Curve; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D012680:Sensitivity and Specificity
keywords: aEEG; hypoxic-ischemic encephalopathy; neonatal EEG; neonatal seizures; quantitative EEG; seizure prediction; total EEG power