title: Prediction of Future Epilepsy in Neonates With Hypoxic-Ischemic Encephalopathy Who Received Selective Head Cooling.
abstract: Epilepsy outcomes after therapeutic hypothermia for neonates with hypoxic-ischemic encephalopathy are understudied. The authors used multivariable logistic regression to predict epilepsy in neonates after selective head cooling. Sensitivity analyses used magnetic resonance imaging (MRI) and electroencephalogram (EEG) interpretations by different clinicians. Fifty neonates had 2-year follow-up. Nine developed epilepsy. Predictors included pH ≤6.8 on day of birth (adjusted odds ratio [OR] 19 [95% confidence interval (CI) 1-371]), burst suppression on EEG on day 4 (8.2 [1.3-59]), and MRI deep gray matter injury (OR 33 [2.4-460]). These factors stratify neonates into low (0-1 factors; 3% [0%-14%] risk), medium (2 factors; 56% [21%-86%] risk), and high-risk groups (3 factors; 100% [29%-100%] risk) for epilepsy. The stratification was robust to varying clinical interpretations of the MRI and EEG. Neonates with hypoxic-ischemic encephalopathy who undergo selective head cooling appear at risk of epilepsy if they have 2 to 3 identified factors. If validated, this rule may help counsel families and identify children for close clinical follow-up.
authors.affiliation: 1 Division of Child Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Tiffani L
authors.initials: TL
authors.lastname: McDonough
authors.affiliation: 2 Hackensack Medical Center, Hackensack NJ, USA.
authors.forename: Juliann M
authors.initials: JM
authors.lastname: Paolicchi
authors.affiliation: 3 Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Heier
authors.affiliation: 4 Weill Cornell Medical College, New York, NY, USA.
authors.forename: Nikkan
authors.initials: N
authors.lastname: Das
authors.affiliation: 5 Division of Child Neurology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Murray
authors.initials: M
authors.lastname: Engel
authors.affiliation: 6 Division of Neonatology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Perlman
authors.affiliation: 5 Division of Child Neurology, Weill Cornell Medical Center, New York, NY, USA.|7 Department of Healthcare Policy & Research, Division of Health Policy and Economics, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Grinspan
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006257:Head; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D020925:Hypoxia-Ischemia, Brain / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: all epilepsy / seizures; childhood stroke; cohort studies; epilepsy; risk factors in epidemiology