title: Value of electroencephalographic monitoring in newborns with hypoxic-ischemic encephalopathy treated with hypothermia.
abstract: BACKGROUND
  The values of electroencephalography (EEG) in neonatal hypoxic-ischemic encephalopathy (HIE) during therapeutic hypothermia (TH) are still uncertain.
  
  
  OBJECTIVE
  The aim of this study is to detect EEG background, the prevalence of seizures during cooling, and to determine different EEG patterns that can predict brain injury in magnetic resonance imaging (MRI).
  
  
  METHODS
  Thirty-nine newborns with HIE were subjected to TH. Continuous monitoring by video-EEG was carried out throughout cooling and during rewarming. MRI was done for all newborns after rewarming. The predictive value of EEG background for MRI brain injury was evaluated at 6-h intervals during cooling and rewarming.
  
  
  RESULTS
  At all-time intervals, normal EEG was associated with no or mild MRI brain injury. At the beginning of cooling, normal background was more predictive of a favorable MRI outcome than at later time points. After 24 h of monitoring, diffuse burst suppression and depressed patterns had the greatest prognostic value. In most patients, a discontinuous pattern was not associated with poor prognosis. Thirty-one percent developed electrical seizures, and 8% developed status epilepticus. Seizures were subclinical in 42%. There is a significant association between duration of seizure patterns detected on the EEG and severity of brain injury on MRI.
  
  
  CONCLUSIONS
  Continuous EEG monitoring in newborns with HIE under cooling has a prognostic value about early MRI brain injury and identifies electrographic seizures, approximately 50% of which are subclinical. Treatment of clinical and subclinical seizure results in a reduction of the total duration of seizure pattern supports the hypothesis that subclinical seizures should be treated.
authors.affiliation: Department of Pediatrics, Menoufia University, Al Minufya, Egypt.
authors.forename: Hatem Hamed
authors.initials: HH
authors.lastname: Elshorbagy
authors.affiliation: Department of Pediatrics, Benha University, Banha, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Azab
authors.affiliation: Department of Pediatrics, Cairo University, Giza, Egypt.
authors.forename: Naglaa M
authors.initials: NM
authors.lastname: Kamal
authors.affiliation: Department of Pediatrics, Menoufia University, Al Minufya, Egypt.
authors.forename: Naglaa Fathy
authors.initials: NF
authors.lastname: Barseem
authors.affiliation: Department of Pediatrics, Tanta University, Tanta, Egypt.
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Bassiouny
authors.affiliation: Department of Pediatrics, Benha University, Banha, Egypt.
authors.forename: Mostafa A
authors.initials: MA
authors.lastname: Elsayed
authors.affiliation: Department of Radiology, Benha University, Banha, Egypt.
authors.forename: Tohamy H
authors.initials: TH
authors.lastname: Elkhouly
keywords: Electroencephalographic monitoring; hypoxic-ischemic encephalopathy; therapeutic hypothermia