Early human development · 2025
Five-year outcomes after cooling for hypoxic-ischemic encephalopathy and predictive value of aEEG.
СтатьяНазвание и аннотация: Перевод в очереди
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Blommaert Dorian, Bos Arend F, den Heijer Anne E, Ter Horst Hendrik J
Аннотация
BACKGROUND: Therapeutic hypothermia (TH) is standard practice for neonatal hypoxic-ischemic encephalopathy (HIE). Persistently abnormal amplitude-integrated electroencephalography (aEEG) background patterns are associated with adverse outcomes. We aimed to determine neurodevelopmental outcomes at age five and the predictive value of aEEG.
STUDY DESIGN: We studied infants with HIE treated with TH between 2013 and 2018. At age five, we assessed motor (neurological examination, movement-ABC) and cognitive outcomes. We classified children as developing typically (IQ ≥ 85 and M-ABC > p16), mildly abnormal (IQ 70-84 and/or cerebral palsy with GMFCS 1-2 and/or M-ABC ≤ p16), and severely abnormal (IQ < 70 and/or cerebral palsy GMFCS >2). During the first 96 h after birth, we assessed aEEG background patterns and presence of seizures.
RESULTS: Out of 95 infants 14 (15 %) died and we lost 18 (22 %) survivors to follow-up. At age five, 33 (52 %) were developing typically, 21 (33 %) mildly abnormal, and 9 (14 %) severely abnormal. A severely abnormal aEEG at 48 h was the best predictor for death/severely abnormal outcome with a PPV of 88 %, and a PPV of 71 % for severe disability in survivors. Children with death/severely abnormal outcomes had electrographic seizures more frequently and a higher seizure burden than children developing typically/mildly abnormal (61 % vs 11 %, P < .001, median 40 vs 0 min, P < .001. Absence of electrographic seizures was highly predictive (NPV 92 %) of typical/mildly abnormal outcome in survivors.
CONCLUSION: Among survivors, five-year outcomes after TH were favorable. aEEG background patterns at 48 h and seizure burden were reliable predictors of five-year outcomes.
STUDY DESIGN: We studied infants with HIE treated with TH between 2013 and 2018. At age five, we assessed motor (neurological examination, movement-ABC) and cognitive outcomes. We classified children as developing typically (IQ ≥ 85 and M-ABC > p16), mildly abnormal (IQ 70-84 and/or cerebral palsy with GMFCS 1-2 and/or M-ABC ≤ p16), and severely abnormal (IQ < 70 and/or cerebral palsy GMFCS >2). During the first 96 h after birth, we assessed aEEG background patterns and presence of seizures.
RESULTS: Out of 95 infants 14 (15 %) died and we lost 18 (22 %) survivors to follow-up. At age five, 33 (52 %) were developing typically, 21 (33 %) mildly abnormal, and 9 (14 %) severely abnormal. A severely abnormal aEEG at 48 h was the best predictor for death/severely abnormal outcome with a PPV of 88 %, and a PPV of 71 % for severe disability in survivors. Children with death/severely abnormal outcomes had electrographic seizures more frequently and a higher seizure burden than children developing typically/mildly abnormal (61 % vs 11 %, P < .001, median 40 vs 0 min, P < .001. Absence of electrographic seizures was highly predictive (NPV 92 %) of typical/mildly abnormal outcome in survivors.
CONCLUSION: Among survivors, five-year outcomes after TH were favorable. aEEG background patterns at 48 h and seizure burden were reliable predictors of five-year outcomes.