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Hortigüela MM, Martínez-Biarge M, Conejo D, Vega-Del-Val C, Arnaez J. Motor, cognitive and behavioural outcomes after neonatal hypoxic-ischaemic encephalopathy. An Pediatr (Barc) 2024; 100:104-114. [PMID: 38331678 DOI: 10.1016/j.anpede.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION The current neurodevelopmental status of patients with neonatal hypoxic-ischaemic encephalopathy (HIE) in Spain is unknown. Recent European studies highlight a shift of severe pathology towards mild motor disorders and emotional problems. The aim of this study was to analyse neurodevelopmental outcomes in a cohort of neonates with HIE at age 3 years. PATIENTS AND METHOD Multicentre observational study of neonates born at 35 or more weeks of gestation with moderate to severe HIE in 2011-2013 in 12 hospitals in a large Spanish region (91 217 m2), with the recruitment extended through 2017 in the coordinating hospital. We analysed the findings of neonatal neuroimaging and neurodevelopmental test scores at 3 years (Bayley-III, Peabody Picture Vocabulary Test and Child Behavior Checklist). The sample included 79 controls with no history of perinatal asphyxia. RESULTS Sixty-three patients were recruited, of whom 5 (7.9%) were excluded due to other pathology and 14 (24%) died. Of the 44 survivors, 42 (95.5%) were evaluated. Of these 42, 10 (24%) had adverse outcomes (visual or hearing impairment, epilepsy, cerebral palsy or developmental delay). Other detected problems were minor neurological signs in 6 of the 42 (14%) and a higher incidence of emotional problems compared to controls: introversion (10.5% vs. 1.3%), anxiety (34.2% vs. 11.7%) and depression (28.9% vs. 7.8%) (P < .05). The severity of the lesions on neuroimaging was significantly higher in patients with motor impairment (P = .004) or who died or had an adverse outcome (P = .027). CONCLUSION In addition to classical sequelae, the followup of patients with neonatal HIE should include the diagnosis and treatment of minor motor disorders and social and emotional problems.
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Affiliation(s)
| | | | - David Conejo
- Servicio de Pediatría, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Juan Arnaez
- Unidad de Neonatología, Hospital Universitario de Burgos, Burgos, Spain; Neurología Neonatal, Fundación NeNe, Madrid, Spain; SIBEN, Nueva Yersey, USA.
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Chock VY, Rao A, Van Meurs KP. Optimal neuromonitoring techniques in neonates with hypoxic ischemic encephalopathy. Front Pediatr 2023; 11:1138062. [PMID: 36969281 PMCID: PMC10030520 DOI: 10.3389/fped.2023.1138062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/20/2023] [Indexed: 03/29/2023] Open
Abstract
Neonates with hypoxic ischemic encephalopathy (HIE) are at significant risk for adverse outcomes including death and neurodevelopmental impairment. Neuromonitoring provides critical diagnostic and prognostic information for these infants. Modalities providing continuous monitoring include continuous electroencephalography (cEEG), amplitude-integrated electroencephalography (aEEG), near-infrared spectroscopy (NIRS), and heart rate variability. Serial bedside neuromonitoring techniques include cranial ultrasound and somatic and visual evoked potentials but may be limited by discrete time points of assessment. EEG, aEEG, and NIRS provide distinct and complementary information about cerebral function and oxygen utilization. Integrated use of these neuromonitoring modalities in addition to other potential techniques such as heart rate variability may best predict imaging outcomes and longer-term neurodevelopment. This review examines available bedside neuromonitoring techniques for the neonate with HIE in the context of therapeutic hypothermia.
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Lori S, Bertini G, Bastianelli ME, Gabbanini S, Cossu C, Mortilla M, Dani C. Continous somatosensory evoked potentials and brain injury in neonatal hypoxic-ischaemic encephalopathy treated with hypothermia. Dev Med Child Neurol 2022; 64:1123-1130. [PMID: 35225350 DOI: 10.1111/dmcn.15190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
AIM To explore whether continuous somatosensory evoked potentials (SEPs) monitoring and video electroencephalograms (VEEG) accurately predict lesions observed on brain magnetic resonance imaging (MRI) in neonates with hypoxic-ischaemic encephalopathy (HIE) receiving therapeutic hypothermia. METHOD This prospective study included 31 neonates (16 males, 15 females; mean [SD] gestational age 39 weeks [1.67]) who received therapeutic hypothermia for HIE. Therapeutic hypothermia was provided for 72 hours, with a target temperature of 33.0°C to 34.0°C and this was followed by a rewarming rate of approximately 0.5°C per hour, up to 36.5°C. SEPs and VEEG were evaluated simultaneously and continuously for 1 hour under normothermic conditions. MRI was carried out at a mean (SD) age of 6 (2) days. RESULTS Our results showed a statistically significant correlation between continuous SEP and MRI scores (r=0.37, p=0.03), but not between the VEEG and MRI scores (r=0.30, p=0.09). Receiver operating characteristic analysis confirmed that continuous SEPs were highly specific and sensitive at predicting MRI abnormalities, whereas the VEEG had high specificity but low sensitivity. INTERPRETATION Continuous monitoring of SEPs could provide early and important prognostic information in neonates with HIE. WHAT THIS PAPER ADDS Early continuous somatosensory evoked potential (SEP) monitoring is correlated with hypoxic-ischaemic encephalopathy (HIE) lesions. Video electroencephalograms (VEEGs) are associated with lesions diagnosed after magnetic resonance imaging. Both showed high specificity, but VEEGs did not show high sensitivity. Continuously monitoring SEPs provides important information about HIE.
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Affiliation(s)
- Silvia Lori
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Giovanna Bertini
- Division of Neonatology, Careggi University Hospital, Florence, Italy
| | - Maria Elena Bastianelli
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Simonetta Gabbanini
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Cesarina Cossu
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | | | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
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Cavaliere S, Lori S, Bastianelli M, Cossu C, Gabbanini S, Dani C, Bertini G. Unilateral Transient Enhanced SEP during Integrated Multiparameter Neurophysiological Monitoring in a Newborn with Symptomatic Seizure. Pediatr Rep 2022; 14:254-261. [PMID: 35736655 PMCID: PMC9230835 DOI: 10.3390/pediatric14020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
During Integrated Multiparametric Neurophysiological Monitoring (IMNA), a newborn with suspected hypoxia at birth and microhaemorrhagic and ischaemic lesions presented some clonic-tonic episodes with specific EEG patterns characterized by rolandic and temporal spikes and the appearance of a unilateral enhanced Somatosensory Evoked Potential (SEP) (10.45 µv). Since the literature does not seem to describe cases of giant SEP in newborns, in this case report, we will discuss the hypotheses underlying this potential. It could be assumed that the ischaemic and haemorrhagic lesions presented by the newborn may have developed as a result of neurotransmitter balance failure. This may be the origin of the EEG picture, which, consequently, could have triggered a potential with high amplitude.
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Affiliation(s)
- Sara Cavaliere
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, 50134 Florence, Italy; (S.C.); (C.D.)
| | - Silvia Lori
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Maria Bastianelli
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Cesarina Cossu
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Simonetta Gabbanini
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, 50134 Florence, Italy; (S.L.); (M.B.); (C.C.); (S.G.)
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, 50134 Florence, Italy; (S.C.); (C.D.)
| | - Giovanna Bertini
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, 50134 Florence, Italy; (S.C.); (C.D.)
- Correspondence:
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Arriaga-Redondo M, Bravo DB, Del Hoyo AA, Arrondo AP, Martín YR, Sánchez-Luna M. Prognostic value of somatosensory-evoked potentials in the newborn with hypoxic-ischemic encephalopathy after the introduction of therapeutic hypothermia. Eur J Pediatr 2022; 181:1609-1618. [PMID: 35066625 DOI: 10.1007/s00431-021-04336-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED To establish the ability of somatosensory-evoked potentials (SEPs) to detect neurological damage in neonatal patients with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). Retrospective study including 84 neonates ≥ 36 weeks of gestational age with HIE and TH with SEPs performed in the first 14 days of life. SEPs from the median nerve were performed after completion of TH. Either unilateral or bilateral absence of N20, or unilateral or bilateral latency ≥ 36 ms, was considered pathological. All newborns underwent a cerebral resonance imaging (MRI) at between days 7 and 14 of life and a neurodevelopmental evaluation using the Brunet-Lezine test at two years of age; a global Brunet-Lezine test score < 70 was considered unfavorable. The risk of moderate-to-severe alteration on basal ganglia-thalamic (BGT) and/or white matter areas on MRI for pathological SEPs was as follows: odds ratio 95% IC: 23.1 (6.9-76.9), sensitivity 78.6%, specificity 86.3%, positive predictive value 75.9%, and negative predictive value 88%. The BGT and internal capsule were the areas with the greatest risk of lesion with an altered SEPs: odds ratio 95% IC 93.1 (11.1-777.8). The risk of neurodevelopmental impairment for pathological SEPs was odds ratio 95% IC: 38.5 (4.4-335.3), sensitivity 91.7%, specificity 77.8% positive predictive value 52.4%, and negative predictive value 97.2%. CONCLUSION The present study demonstrates the good predictive capacity of SEPs performed in the first two weeks of life in newborns with HIE and TH to detect an increased risk of neuroimaging lesions and neurodevelopmental impairment at two years of age. WHAT IS KNOWN • Bilateral absence of the N20 cortical component of somatosensory evoked potentials has been associated with poor neurological outcome in neonates with hypoxic-ischemic encephalopathy. WHAT IS NEW • This work confirms the predictive capacity of SEPs by adding two important aspects: the value of latency when interpreting SEPs results and the absence of effect of the hypothermia method used on the results of SEPs.
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Affiliation(s)
- María Arriaga-Redondo
- Neonatology Department, Neonatology Division, Gregorio Marañón University Hospital, C/Maiquez 9, 28009, Madrid, Spain.
| | - Dorotea Blanco Bravo
- Neonatology Department, Neonatology Division, Gregorio Marañón University Hospital, C/Maiquez 9, 28009, Madrid, Spain
| | | | - Ana Polo Arrondo
- Neurophysiology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Manuel Sánchez-Luna
- Neonatology Department, Neonatology Division, Gregorio Marañón University Hospital, C/Maiquez 9, 28009, Madrid, Spain
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Ismail FY, Saleem GT, Ljubisavljevic MR. Brain Data in Pediatric Disorders of Consciousness: Special Considerations. J Clin Neurophysiol 2022; 39:49-58. [PMID: 34474425 DOI: 10.1097/wnp.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY The diagnosis and management of disorders of consciousness in children continue to present a clinical, research, and ethical challenge. Though the practice guidelines for diagnosis and management of disorders of consciousness in adults are supported by decades of empirical and pragmatic evidence, similar guidelines for infants and children are lacking. The maturing conscious experience and the limited behavioral repertoire to report consciousness in this age group restrict extrapolation from the adult literature. Equally challenging is the process of heightened structural and functional neuroplasticity in the developing brain, which adds a layer of complexity to the investigation of the neural correlates of consciousness in infants and children. This review discusses the clinical assessment of pediatric disorders of consciousness and delineates the diagnostic and prognostic utility of neurophysiological and neuroimaging correlates of consciousness. The potential relevance of these correlates for the developing brain based on existing theoretical models of consciousness in adults is outlined.
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Affiliation(s)
- Fatima Y Ismail
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Neurology (Adjunct), Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Ghazala T Saleem
- Department of Rehabilitation Science, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, U.S.A.; and
| | - Milos R Ljubisavljevic
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Delval A, Girard B, Lacan L, Chaton L, Flamein F, Storme L, Derambure P, The Tich SN, Lamblin MD, Betrouni N. Neurophysiological recordings improve the accuracy of the evaluation of the outcome in perinatal hypoxic ischemic encephalopathy. Eur J Paediatr Neurol 2022; 36:51-56. [PMID: 34890946 DOI: 10.1016/j.ejpn.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Our objective was to evaluate the potential additional value of electroencephalogram (EEG) and evoked potentials in neonates with hypoxic-ischemic encephalopathy to predict their disability at 1 and 2 years old. METHODS 30 full-term infants after perinatal asphyxia who underwent therapeutic hypothermia were evaluated at 1 year and 2 years for disability using International Classification of Functioning, Disability and Health classification. Scores for EEG, sensory evoked potentials and brainstem auditory evoked potentials were evaluated after withdrawal of therapeutic hypothermia that lasted 72 h. A regression approach was investigated to build models allowing to distinguish neonates according to their disability at 1 and 2 years. Two models were built, the first by considering the clinical data and EEG before and after therapeutic hypothermia and the second by incorporating evoked potentials recording. RESULTS Adding EEG and evoked potentials data after rewarming improved dramatically the accuracy of the model considering outcome at 1 and 2 years. INTERPRETATION We propose to record systematically EEG and evoked potentials following rewarming to predict the outcome of neonates with hypoxic ischemic encephalopathy. Combination of altered evoked potentials with no improvement of EEG after rewarming appeared to be a robust criterion for a poor outcome.
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Affiliation(s)
- Arnaud Delval
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France.
| | - Barbara Girard
- Children Department of Physical Medicine and Rehabilitation, Institut Régional de Réadaptation, Flavigny sur Moselle, France
| | - Laure Lacan
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France; Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Laurence Chaton
- Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Florence Flamein
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France
| | - Laurent Storme
- Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Philippe Derambure
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Sylvie Nguyen The Tich
- EA4489, Environnement Périnatal et Santé, Faculté de Médecine, Université de Lille, France; Pediatric Neurology Department, Lille University Medical Center, F-59000, Lille, France
| | - Marie-Dominique Lamblin
- Clinical Neurophysiology Department, Lille University Medical Center, F-59000, Lille, France
| | - Nacim Betrouni
- Univ. Lille, Inserm, U1172 - Lille, Neuroscience Cognition, F-59000, Lille, France
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Kamino D, Almazrooei A, Pang EW, Widjaja E, Moore AM, Chau V, Tam EWY. Abnormalities in evoked potentials associated with abnormal glycemia and brain injury in neonatal hypoxic-ischemic encephalopathy. Clin Neurophysiol 2020; 132:307-313. [PMID: 33158762 DOI: 10.1016/j.clinph.2020.09.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/16/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate how functional integrity of ascending sensory pathways measured by visual and somatosensory evoked potentials (VEP & SEP) is associated with abnormal glycemia and brain injury in newborns treated with hypothermia for hypoxic-ischemic encephalopathy (HIE). METHODS Fifty-four neonates ≥ 36 weeks gestational age with HIE underwent glucose testing, VEPs, SEPs, and magnetic resonance imaging (MRI) the first week of life. Minimum and maximum glucose values recorded prior to evoked potential (EP) testing were compared with VEP and SEP measures using generalized estimating equations. Relationships between VEP and SEP measures and brain injury on MRI were assessed. RESULTS Maximum glucose is associated with decreased P200 amplitude, and increased odds that N300 peak will be delayed/absent. Minimum glucose is associated with decreased P22 amplitude. Presence of P200 and N300 peaks is associated with decreased odds of brain injury in the visual processing pathway, with delayed/absent N300 peak associated with increased odds of brain injury in posterior white matter. CONCLUSIONS Deviations from normoglycemia are associated with abnormal EPs, and abnormal VEPs are associated with brain injury on MRI in cooled neonates with HIE. SIGNIFICANCE Glucose is a modifiable risk factor associated with atypical brain function in neonates with HIE despite hypothermia treatment.
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Affiliation(s)
- Daphne Kamino
- The Hospital for Sick Children and University of Toronto, Department of Pediatrics (Division of Neurology), Toronto, ON M5G 1X8, Canada
| | - Asma Almazrooei
- The Hospital for Sick Children and University of Toronto, Department of Pediatrics (Division of Neurology), Toronto, ON M5G 1X8, Canada
| | - Elizabeth W Pang
- The Hospital for Sick Children and University of Toronto, Department of Pediatrics (Division of Neurology), Toronto, ON M5G 1X8, Canada; Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON M5G 0A4, Canada
| | - Elysa Widjaja
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON M5G 0A4, Canada; The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto, ON M5G 1X8, Canada
| | - Aideen M Moore
- The Hospital for Sick Children and University of Toronto, Department of Pediatrics (Division of Neonatology), Toronto, ON M5G 1X8, Canada
| | - Vann Chau
- The Hospital for Sick Children and University of Toronto, Department of Pediatrics (Division of Neurology), Toronto, ON M5G 1X8, Canada; Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON M5G 0A4, Canada
| | - Emily W Y Tam
- The Hospital for Sick Children and University of Toronto, Department of Pediatrics (Division of Neurology), Toronto, ON M5G 1X8, Canada; Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON M5G 0A4, Canada.
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Liu W, Yang Q, Wei H, Dong W, Fan Y, Hua Z. Prognostic Value of Clinical Tests in Neonates With Hypoxic-Ischemic Encephalopathy Treated With Therapeutic Hypothermia: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:133. [PMID: 32161566 PMCID: PMC7052385 DOI: 10.3389/fneur.2020.00133] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/05/2020] [Indexed: 12/17/2022] Open
Abstract
Background and Objective: There remains an unmet clinical need for markers that predict outcomes in the hypothermia-treated (HT) infants with HIE. The aim of this meta-analysis was to investigate the prognostic accuracy of currently available clinical tests performed in the immediate post-natal period for predicting neurological outcomes between 18 months and 3 years of age in HT near-term and term infants with perinatal asphyxia and HIE. Methods: A comprehensive review of the Embase, Cochrane library, and PubMed databases was performed to identify studies that evaluated the prognostic value of clinical tests for neurological outcomes in HT near-term and term infants with perinatal asphyxia and hypoxic-ischemic encephalopathy. Pooled sensitivity and specificity with corresponding 95% confidence intervals and area under the receiver operating characteristic (ROC) curve (AUC) were calculated. Results: Of the 1,144 relevant studies, 26 studies describing four clinical tests conducted in 1458 HT near-term or term infants were included. For predicting an unfavorable neurological outcome, of the imaging techniques, MRI within 2 weeks of birth performed best on sensitivity 0.85 (95% CI 0.79–0.89), specificity 0.72 (95% CI 0.66–0.77), and AUC 0.88; among the neurophysiological tests, multichannel EEG (Electroencephalogram) demonstrated the sensitivity 0.63 (95% CI 0.49–0.76), specificity 0.82 (95% CI 0.70–0.91), and AUC 0.88, and for aEEG (amplitude-integrated electroencephalography) background pattern pooled sensitivity, specificity and AUC were 0.90 (95% CI 0.86–0.94), 0.46 (95% CI 0.42–0.51), and 0.78 whereas for SEPs (Somatosensory evoked potentials), pooled sensitivity and specificity were 0.52 (95% CI 0.34–0.69), 0.76 (95% CI 0.63–0.87), and AUC 0.84, respectively. Conclusions: In the wake of the era of TH, MRI and neurophysiological tests (aEEG or EEG) were promising predictors of adverse outcomes, while SEPs need high-quality studies to confirm the findings. Continued follow-up of the children and well-designed large prospective studies are essential to determine whether these benefits are maintained in later childhood.
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Affiliation(s)
- Weiqin Liu
- Department of Neonatology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qifen Yang
- School of Life Sciences, SouthWest University, Chongqing, China
| | - Hong Wei
- Department of Neonatology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wenhui Dong
- Department of Neonatology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Fan
- Department of Neonatology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ziyu Hua
- Department of Neonatology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
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10
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Ouwehand S, Smidt LCA, Dudink J, Benders MJNL, de Vries LS, Groenendaal F, van der Aa NE. Predictors of Outcomes in Hypoxic-Ischemic Encephalopathy following Hypothermia: A Meta-Analysis. Neonatology 2020; 117:411-427. [PMID: 32235122 DOI: 10.1159/000505519] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prediction of neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy remains an important challenge. Various studies have shown that the predictive ability of different modalities changed after the introduction of therapeutic hypothermia. This paper reviews the diagnostic test accuracy of the different modalities that are being used to predict neurodevelopmental outcomes following therapeutic hypothermia. METHODS A systematic literature search was performed using Embase and PubMed. Two reviewers independently included eligible studies and extracted data. The quality of the studies was assessed using the Quality in Prognosis Studies Tool. Meta-analyses were performed where possible. RESULTS Forty-seven articles and 3 conference abstracts were included, reporting on 3,072infants of whom 39% died or had an adverse neurodevelopmental outcome. A meta-analysis could be performed using 37 articles on (amplitude-integrated) electroencephalography (EEG), conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and proton magnetic resonance spectroscopy (1H-MRS). Amplitude-integrated EEG (aEEG) at 24 and 72 h showed similar high diagnostic OR, while aEEG at 6 h and EEG performed less, both due to a low specificity. For MRI, most studies reported scoring systems in which early (<8 days) MRI performed better than late (≥8 days) MRI. Injury to the posterior limb of the internal capsule on MRI or to the thalami on DWI were strong individual predictors, as was an increased lactate/N-acetylaspartate peak on 1H-MRS. CONCLUSIONS In the era of therapeutic hypothermia, the different modalities remain good predictors of neurodevelopmental outcome. However, timing should be taken into account. aEEG may initially be false positive and gets more reliable after 24 h. In contrast, MRI should be used during the first week, as its predictive value decreases afterwards.
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Affiliation(s)
- Sabine Ouwehand
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisanne C A Smidt
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands, .,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Barkhuizen M, Vles JSH, van Mechelen R, Vermeer M, Kramer BW, Chedraui P, Bergs P, van Kranen-Mastenbroek VHJM, Gavilanes AWD. Preterm Perinatal Hypoxia-Ischemia Does not Affect Somatosensory Evoked Potentials in Adult Rats. Diagnostics (Basel) 2019; 9:E123. [PMID: 31540369 PMCID: PMC6787632 DOI: 10.3390/diagnostics9030123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 11/17/2022] Open
Abstract
Somatosensory evoked potentials (SSEPs) are a valuable tool to assess functional integrity of the somatosensory pathways and for the prediction of sensorimotor outcome in perinatal injuries, such as perinatal hypoxia-ischemia (HI). In the present research, we studied the translational potential of SSEPs together with sensory function in the male adult rat with perinatal HI compared to the male healthy adult rat. Both somatosensory response and evoked potential were measured at 10-11 months after global perinatal HI. Clear evoked potentials were obtained, but there were no group differences in the amplitude or latency of the evoked potentials of the preceding sensory response. The bilateral tactile stimulation test was also normal in both groups. This lack of effect may be ascribed to the late age-of-testing and functional recovery of the rats.
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Affiliation(s)
- Melinda Barkhuizen
- Department of Pediatrics, Maastricht University Medical Centre (MUMC), 6229HX, Maastricht, The Netherlands.
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, 6229 HX, Maastricht, The Netherlands.
- DST/NWU Preclinical Drug Development Platform, North-West University, Potchefstroom 2531, South Africa.
| | - Johan S H Vles
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, 6229 HX, Maastricht, The Netherlands.
- Child Neurology, Maastricht University Medical Centre, 6229 HX, Maastricht, The Netherlands.
| | - Ralph van Mechelen
- Department of Pediatrics, Maastricht University Medical Centre (MUMC), 6229HX, Maastricht, The Netherlands.
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, 6229 HX, Maastricht, The Netherlands.
| | - Marijne Vermeer
- Department of Pediatrics, Maastricht University Medical Centre (MUMC), 6229HX, Maastricht, The Netherlands.
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, 6229 HX, Maastricht, The Netherlands.
| | - Boris W Kramer
- Department of Pediatrics, Maastricht University Medical Centre (MUMC), 6229HX, Maastricht, The Netherlands.
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, 6229 HX, Maastricht, The Netherlands.
| | - Peter Chedraui
- Instituto de Investigación e Innovación de Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil 090615, Ecuador.
| | - Paul Bergs
- Clinical Neurophysiology, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands.
| | | | - Antonio W D Gavilanes
- Department of Pediatrics, Maastricht University Medical Centre (MUMC), 6229HX, Maastricht, The Netherlands.
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University, 6229 HX, Maastricht, The Netherlands.
- Instituto de Investigación e Innovación de Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil 090615, Ecuador.
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12
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Abstract
Hypoxic-ischemic encephalopathy is a subtype of neonatal encephalopathy and a major contributor to global neonatal morbidity and mortality. Despite advances in obstetric and neonatal care there are still challenges in accurate determination of etiology of neonatal encephalopathy. Thus, identification of intrapartum risk factors and comprehensive evaluation of the neonate is important to determine the etiology and severity of neonatal encephalopathy. In developed countries, therapeutic hypothermia as a standard of care therapy for neonates with hypoxic-ischemic encephalopathy has proven to decrease incidence of death and neurodevelopmental disabilities, including cerebral palsy in surviving children. Advances in neuroimaging, brain monitoring modalities, and biomarkers of brain injury have improved the ability to diagnose, monitor, and treat newborns with encephalopathy. However, challenges remain in early identification of neonates at risk for hypoxic-ischemic brain injury, and determination of the timing and extent of brain injury. Using imaging studies such as Neonatal MRI and MR spectroscopy have proven to be most useful in predicting outcomes in infants with encephalopathy within the first week of life, although comprehensive neurodevelopmental assessments still remains the gold standard for determining long term outcomes. Future studies are needed to identify other newborns with encephalopathy that might benefit from therapeutic hypothermia and to determine the efficacy of other adjunctive neuroprotective strategies. This review focuses on newer evidence and advances in diagnoses and management of infants with neonatal encephalopathy, including novel therapies, as well as prognostication of outcomes to childhood.
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Cainelli E, Trevisanuto D, Cavallin F, Manara R, Suppiej A. Evoked potentials predict psychomotor development in neonates with normal MRI after hypothermia for hypoxic-ischemic encephalopathy. Clin Neurophysiol 2018; 129:1300-1306. [PMID: 29689487 DOI: 10.1016/j.clinph.2018.03.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/21/2018] [Accepted: 03/26/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the prognostic role of evoked potentials (EP) in neonates with normal magnetic resonance imaging (MRI) after therapeutic hypothermia (TH) for hypoxic-ischemic encephalopathy (HIE). METHODS Thirty-five neonates recruited for TH because of HIE, having normal neonatal MRI, performed neonatal somatosensory (SEP), visual (VEP) evoked potentials and electroencephalogram (EEG). The effect of SEP, VEP or EEG abnormalities on Griffith's developmental scales at 12 and 24 months was measured; positive (PPV) and negative (NPV) predictive value, sensitivity, specificity and accuracy were calculated. RESULTS At 24 months, 28% had global psychomotor impairment and 57% had isolated impairments. VEP abnormality was associated with impaired hearing-language score (p = 0.002) and performance score (p < 0.0001). VEP achieved best PPV (0.91, 95% C.I. 0.62-0.99) and specificity (0.93, 95% C.I. 0.70-0.99). The combination of neurophysiological tests achieved the best NPV (0.85, 95% C.I. 0.58-0.96), sensitivity (0.90, 95% C.I. 0.70-0.97), overall accuracy (0.83, 95% C.I. 0.67-0.92). CONCLUSIONS Psychomotor sequelae may occur in survivors of neonatal HIE with normal MRI. VEP is the single best neurophysiological prognostic marker but the combination of neurophysiological tests has a better value. SIGNIFICANCE When facing the challenge of neurodevelopmental prognosis in infants with normal MRI after TH, EPs are useful prognostic tools, complementary to EEG.
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Affiliation(s)
- Elisa Cainelli
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital of Padua, Italy
| | | | | | | | - Agnese Suppiej
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital of Padua, Italy.
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14
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Suppiej A, Cappellari A, Talenti G, Cainelli E, Di Capua M, Janes A, Longo D, Mardari R, Marinaccio C, Pro S, Sciortino P, Trevisanuto D, Vittorini R, Manara R. Bilateral loss of cortical SEPs predict severe MRI lesions in neonatal hypoxic ischemic encephalopathy treated with hypothermia. Clin Neurophysiol 2017; 129:95-100. [PMID: 29172116 DOI: 10.1016/j.clinph.2017.10.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 10/18/2017] [Accepted: 10/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The introduction of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy calls for reevaluation of the prognostic role of somatosensory evoked potentials (SEPs). METHODS Among 80 consecutive neonates undergoing hypothermia for hypoxic-ischemic encephalopathy, 58 performed SEPs and MRI at 4-14 days of life and were recruited in this multicenter study. SEPs were scored as: 0 (bilaterally/unilaterally recorded N20) or 1 (bilaterally absent N20). The severity of brain injury was scored using MRI. RESULTS Bilaterally absent N20 was observed in 10/58 neonates (17%); all had moderate/severe MRI abnormalities; 36/48 neonates (75%) with score 0 at SEPs had normal MRI. The positive predictive value of SEPs on MRI outcome was of 1.00, while the negative predictive value 0.72, sensitivity 0.48, specificity 1.00, with an accuracy of 0.78 (p < .001). CONCLUSIONS Bilateral absence of cortical SEPs predicts moderate/severe MRI pattern of injury. SIGNIFICANCE Therapeutic hypothermia does not seem to significantly affect prognostic reliability of SEPs.
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Affiliation(s)
- Agnese Suppiej
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital of Padova, Italy.
| | - Ambra Cappellari
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital of Padova, Italy
| | | | - Elisa Cainelli
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital of Padova, Italy
| | - Matteo Di Capua
- Neurophysiology Unit, Department of Neuroscience, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Augusta Janes
- Terapia Intensiva Neonatale Azienda Sanitaria Unica Integrata SMM Udine, Italy
| | - Daniela Longo
- Neuroradiology Unit, Ospedale Pediatrico Bambino Gesù - IRCCS - Roma, Italy
| | - Rodica Mardari
- Neuroradiology Unit, University Hospital of Padova, Italy
| | - Cristina Marinaccio
- SC Neuropsichiatria Infantile Dipartimento di Pediatria e Specialità Pediatriche, A.O.U. Città della Salute e della Scienza Torino, Presidio OIRM, Italy
| | - Stefano Pro
- Neurophysiology Unit, Department of Neuroscience, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Paola Sciortino
- SC Neuroradiologia, Dipartimento di Diagnostica per Immagini e Radioterapia, A.O.U. Città della Salute e della Scienza Torino, Presidio CTO, Italy
| | - Daniele Trevisanuto
- Neonatal Intensive Care Unit, Pediatric University Hospital of Padova, Italy
| | - Roberta Vittorini
- SC Neuropsichiatria Infantile Dipartimento di Pediatria e Specialità Pediatriche, A.O.U. Città della Salute e della Scienza Torino, Presidio OIRM, Italy
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Lori S, Gabbanini S, Bastianelli M, Bertini G, Corsini I, Dani C. Multimodal neurophysiological monitoring in healthy infants born at term: normative continuous somatosensory evoked potentials data. Dev Med Child Neurol 2017; 59:959-964. [PMID: 28432693 DOI: 10.1111/dmcn.13430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
AIM To describe accurate, standardized 1h-multimodal neurophysiological monitoring (1h-MNM), while simultaneously recording VEEG, aEEG, and SEP-C bilaterally from median nerves, and to collect neonatal normative SEP-C data related to behavioural states. METHOD Twenty healthy, term newborn infants (13 males, 7 females; gestational age 37-42wks; mean 39.6wks, standard deviation [SD] 1.3wks) underwent 1h-MNM within 2 days of life, with focus on recording of the SEP-C (band-pass setting 1-100 Hz, rate of stimulation 1.1 Hz, 50 alternate stimuli). RESULTS 1h-MNM was easily obtained with identification of cervical (N13) and cortical (N1, P1) SEP-C responses in all infants. SEP-C minimal and maximum N1 latencies/N1-P1 amplitudes were identified, bilaterally, during periods of spontaneous sleep active-quiet-active (AS-QS-AS) and quiet-wakefulness. Minimal latencies and amplitudes occurred in 60% of active sleep/quiet-wakefulness, with the maximums in 70% of quiet sleep. The SEP-C mean values were latencies of N13=13.6ms (SD 1.4ms) and N1=33.6ms (SD 3.9ms) to 34.2ms (SD 4.8ms) in left and right hemisphere respectively; central-conduction-time (CCT) (N13-N1), 20.0ms (SD 4.3ms) to 20.6ms (SD 4.8ms); N1-P1 amplitude=4.6ms (SD 2.7ms) to 3.8μV (SD 2.2μV). INTERPRETATION 1h-MNM can record simultaneously VEEG/aEEG/SEP-C in newborn infants, showing the modulation of SEP cortical responses in relation to behavioural states in all infants studied using an appropriate neonatal method. We emphasize the importance of obtaining neonatal SEP-C normative data to better identify pathological findings in neonatal brain injury.
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Affiliation(s)
- Silvia Lori
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Simonetta Gabbanini
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Maria Bastianelli
- Neurophysiology Unit, Neuro-Musculo-Skeletal Department, Careggi University Hospital, Florence, Italy
| | - Giovanna Bertini
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Iuri Corsini
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
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16
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Nevalainen P, Lauronen L, Metsäranta M, Lönnqvist T, Ahtola E, Vanhatalo S. Neonatal somatosensory evoked potentials persist during hypothermia. Acta Paediatr 2017; 106:912-917. [PMID: 28258592 DOI: 10.1111/apa.13813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/06/2017] [Accepted: 02/28/2017] [Indexed: 11/29/2022]
Abstract
AIM Treatment with therapeutic hypothermia has challenged the use of amplitude-integrated electroencephalography in predicting outcomes after perinatal asphyxia. In this study, we assessed the feasibility and gain of somatosensory evoked potentials (SEP) during hypothermia. METHODS This retrospective study comprised neonates from 35 + 6 to 42 + 2 gestational weeks and treated for asphyxia or hypoxic-ischaemic encephalopathy at Helsinki University Hospital between 14 February 2007 and 23 December 2009. This period was partly before the introduction of routine therapeutic hypothermia, which enabled us to include normothermic neonates who would these days receive hypothermia treatment. We analysed SEPs from 47 asphyxiated neonates and compared the results between 23 normothermic and 24 hypothermic neonates. RESULTS Our data showed that hypothermia led to SEP latencies lengthening by a few milliseconds, but the essential gain for predicting outcomes by SEPs was preserved during hypothermia. Of the 24 hypothermic neonates, bilaterally absent SEPs were associated with poor outcome in 2/2 neonates, normal SEPs were associated with good outcomes in 13/15 neonates and 5/7 neonates with unilaterally absent or grossly delayed SEPs had a poor outcome. CONCLUSION Our findings indicated that SEPs were a reliable tool for evaluating the somatosensory system in asphyxiated neonates in both normothermic and hypothermic conditions.
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Affiliation(s)
- Päivi Nevalainen
- Department of Clinical Neurophysiology; Children's Hospital; HUS Medical Imaging Center; University of Helsinki and Helsinki University Hospital (HUH); Helsinki Finland
| | - Leena Lauronen
- Department of Clinical Neurophysiology; Children's Hospital; HUS Medical Imaging Center; University of Helsinki and Helsinki University Hospital (HUH); Helsinki Finland
| | - Marjo Metsäranta
- Department of Pediatrics; Children's Hospital; University of Helsinki and HUH; Helsinki Finland
| | - Tuula Lönnqvist
- Department of Child Neurology; Children's Hospital; University of Helsinki and HUH; Helsinki Finland
| | - Eero Ahtola
- Department of Clinical Neurophysiology; Children's Hospital; HUS Medical Imaging Center; University of Helsinki and Helsinki University Hospital (HUH); Helsinki Finland
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology; Children's Hospital; HUS Medical Imaging Center; University of Helsinki and Helsinki University Hospital (HUH); Helsinki Finland
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Nevalainen P, Marchi V, Metsäranta M, Lönnqvist T, Toiviainen-Salo S, Vanhatalo S, Lauronen L. Evoked potentials recorded during routine EEG predict outcome after perinatal asphyxia. Clin Neurophysiol 2017; 128:1337-1343. [PMID: 28570867 DOI: 10.1016/j.clinph.2017.04.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/22/2017] [Accepted: 04/26/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the added value of somatosensory (SEPs) and visual evoked potentials (VEPs) recorded simultaneously with routine EEG in early outcome prediction of newborns with hypoxic-ischemic encephalopathy under modern intensive care. METHODS We simultaneously recorded multichannel EEG, median nerve SEPs, and flash VEPs during the first few postnatal days in 50 term newborns with hypoxic-ischemic encephalopathy. EEG background was scored into five grades and the worst two grades were considered to indicate poor cerebral recovery. Evoked potentials were classified as absent or present. Clinical outcome was determined from the medical records at a median age of 21months. Unfavorable outcome included cerebral palsy, severe mental retardation, severe epilepsy, or death. RESULTS The accuracy of outcome prediction was 98% with SEPs compared to 90% with EEG. EEG alone always predicted unfavorable outcome when it was inactive (n=9), and favorable outcome when it was normal or only mildly abnormal (n=17). However, newborns with moderate or severe EEG background abnormality could have either favorable or unfavorable outcome, which was correctly predicted by SEP in all but one newborn (accuracy in this subgroup 96%). Absent VEPs were always associated with an inactive EEG, and an unfavorable outcome. However, presence of VEPs did not guarantee a favorable outcome. CONCLUSIONS SEPs accurately predict clinical outcomes in newborns with hypoxic-ischemic encephalopathy and improve the EEG-based prediction particularly in those newborns with severely or moderately abnormal EEG findings. SIGNIFICANCE SEPs should be added to routine EEG recordings for early bedside assessment of newborns with hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Päivi Nevalainen
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical, Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland.
| | - Viviana Marchi
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, IRCCS Stella Maris Foundation Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marjo Metsäranta
- Department of Neonatology, Children's Hospital, University of Helsinki and HUH, Helsinki, Finland
| | - Tuula Lönnqvist
- Department of Child Neurology, Children's Hospital, University of Helsinki and HUH, Helsinki, Finland
| | - Sanna Toiviainen-Salo
- HUS Medical Imaging Center, Radiology, University of Helsinki and HUH, Helsinki, Finland
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical, Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
| | - Leena Lauronen
- Department of Clinical Neurophysiology, Children's Hospital, HUS Medical, Imaging Center, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
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18
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Antioxidant polymorphisms do not influence the risk of epilepsy or its drug resistance after neonatal hypoxic-ischemic brain injury. Seizure 2017; 46:38-42. [DOI: 10.1016/j.seizure.2017.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 01/02/2017] [Accepted: 01/31/2017] [Indexed: 11/22/2022] Open
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Esih K, Goričar K, Dolžan V, Rener-Primec Z. The association between antioxidant enzyme polymorphisms and cerebral palsy after perinatal hypoxic-ischaemic encephalopathy. Eur J Paediatr Neurol 2016; 20:704-8. [PMID: 27302388 DOI: 10.1016/j.ejpn.2016.05.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 01/28/2016] [Accepted: 05/25/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypoxic-ischaemic perinatal brain injury leads to the formation of reactive oxygen species (ROS) and the resultant cell and tissue damage may cause neurological sequelae such as cerebral palsy and/or epilepsy. A decrease in the capacity for defending against ROS may increase the susceptibility to cerebral palsy. The aim of this study was to investigate the impact of common functional polymorphisms in the antioxidant genes SOD2, GPX1 and CAT, associated with a decreased capacity for defending against ROS, in patients with perinatal hypoxic-ischaemic encephalopathy (HIE). METHODS 80 patients previously diagnosed with perinatal HIE were included. Genomic DNA was isolated from buccal swabs and genotyped for SOD2 rs4880, GPX1 rs1050450 and CAT rs1001179 using real-time PCR-based methods. RESULTS Among patients with neonatal HIE, carriers of at least one polymorphic CAT rs1001179 T allele were significantly associated with development of cerebral palsy compared to non-carriers (univariate logistic regression, p = 0.026; OR = 3.36; 95% CI = 1.16-9.76). This difference remained statistically significant after accounting for prematurity. The investigated SOD2 and GPX1 polymorphisms were not associated with cerebral palsy after perinatal HIE. CONCLUSION CAT rs1001179 polymorphism could be used to identify children that have a higher susceptibility to cerebral palsy after perinatal HIE.
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Affiliation(s)
- Katarina Esih
- Department of Child, Adolescent and Developmental Neurology, Children's Hospital, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Katja Goričar
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Vita Dolžan
- Pharmacogenetics Laboratory, Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Zvonka Rener-Primec
- Department of Child, Adolescent and Developmental Neurology, Children's Hospital, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia.
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Pisani F, Spagnoli C. Monitoring of newborns at high risk for brain injury. Ital J Pediatr 2016; 42:48. [PMID: 27180227 PMCID: PMC4867092 DOI: 10.1186/s13052-016-0261-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/06/2016] [Indexed: 01/06/2023] Open
Abstract
Due to the increasing number of surviving preterm newborns and to the recognition of therapeutic hypothermia as the current gold standard in newborns with hypoxic-ischaemic encephalopathy, there has been a growing interest in the implementation of brain monitoring tools in newborns at high risk for neurological disorders.Among the most frequent neurological conditions and presentations in the neonatal period, neonatal seizures and neonatal status epilepticus, paroxysmal non-epileptic motor phenomena, hypoxic-ischaemic encephalopathy, white matter injury of prematurity and stroke require specific approaches to diagnosis. In this review we will describe the characteristics, aims, indications and limitations of routinely available diagnostic techniques such as conventional and amplitude-integrated EEG, evoked potentials, cranial ultrasound and brain MRI. We will conclude by briefly outlining potential future perspectives from research studies.
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Affiliation(s)
- Francesco Pisani
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Carlotta Spagnoli
- Child Neuropsychiatry Unit, Neuroscience Department, University of Parma, Via Gramsci 14, 43126, Parma, Italy.
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21
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Electrophysiological Monitoring of Brain Injury and Recovery after Cardiac Arrest. Int J Mol Sci 2015; 16:25999-6018. [PMID: 26528970 PMCID: PMC4661797 DOI: 10.3390/ijms161125938] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/19/2015] [Accepted: 10/21/2015] [Indexed: 11/16/2022] Open
Abstract
Reliable prognostic methods for cerebral functional outcome of post cardiac-arrest (CA) patients are necessary, especially since therapeutic hypothermia (TH) as a standard treatment. Traditional neurophysiological prognostic indicators, such as clinical examination and chemical biomarkers, may result in indecisive outcome predictions and do not directly reflect neuronal activity, though they have remained the mainstay of clinical prognosis. The most recent advances in electrophysiological methods--electroencephalography (EEG) pattern, evoked potential (EP) and cellular electrophysiological measurement--were developed to complement these deficiencies, and will be examined in this review article. EEG pattern (reactivity and continuity) provides real-time and accurate information for early-stage (particularly in the first 24 h) hypoxic-ischemic (HI) brain injury patients with high sensitivity. However, the signal is easily affected by external stimuli, thus the measurements of EP should be combined with EEG background to validate the predicted neurologic functional result. Cellular electrophysiology, such as multi-unit activity (MUA) and local field potentials (LFP), has strong potential for improving prognostication and therapy by offering additional neurophysiologic information to understand the underlying mechanisms of therapeutic methods. Electrophysiology provides reliable and precise prognostication on both global and cellular levels secondary to cerebral injury in cardiac arrest patients treated with TH.
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22
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Zuberi SM. Editorial note. Eur J Paediatr Neurol 2015; 19:389. [PMID: 26043359 DOI: 10.1016/j.ejpn.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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