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Nevalainen P, Metsäranta M, Marchi V, Toiviainen-Salo S, Vanhatalo S, Lauronen L. Towards multimodal brain monitoring in asphyxiated newborns with amplitude-integrated EEG and simultaneous somatosensory evoked potentials. Early Hum Dev 2021; 153:105287. [PMID: 33310460 DOI: 10.1016/j.earlhumdev.2020.105287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/26/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Somatosensory evoked potentials (SEPs) offer an additional bedside tool for outcome prediction after perinatal asphyxia. AIMS To assess the reliability of SEPs recorded with bifrontoparietal amplitude-integrated electroencephalography (aEEG) brain monitoring setup for outcome prediction in asphyxiated newborns undergoing therapeutic hypothermia. STUDY DESIGN Retrospective observational single-center study. SUBJECTS 27 consecutive asphyxiated full- or near-term newborns (25 under hypothermia) that underwent median nerve aEEG-SEPs as part of their clinical evaluation at the neonatal intensive care unit of Helsinki University Hospital. OUTCOME MEASURES aEEG-SEP classification (present, absent or unreliable) was compared to classification of SEPs recorded with a full EEG montage (EEG-SEP), and outcome determined from medical records at approximately 12-months-age. Unfavorable outcome included death, cerebral palsy, or severe epilepsy. RESULTS The aEEG-SEP and EEG-SEP classifications were concordant in 21 of the 22 newborns with both recordings available. All five newborns with bilaterally absent aEEG-SEPs had absent EEG-SEPs and the four with outcome information available had an unfavorable outcome (one was lost to follow-up). Of the newborns with aEEG-SEPs present, all with follow-up exams available had bilaterally present EEG-SEPs and a favorable outcome (one was lost to follow-up). One newborn with unilaterally absent aEEG-SEP at 25 h of age had bilaterally present EEG-SEPs on the next day, and a favorable outcome. CONCLUSIONS aEEG-SEPs recorded during therapeutic hypothermia on the first postnatal days are reliable for assessing brain injury severity. Adding SEP into routine aEEG brain monitoring offers an additional tool for very early outcome prediction after birth asphyxia.
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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; BABA Center, Children's Hospital and Pediatric Research Center, University of Helsinki and HUH, Helsinki, Finland.
| | - Marjo Metsäranta
- Department of Pediatrics, Children's Hospital, University of Helsinki and HUH, Helsinki, Finland
| | - Viviana Marchi
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, IRCCS Stella Maris Foundation Pisa, Italy
| | - Sanna Toiviainen-Salo
- Department of Pediatric Radiology, Children's Hospital, 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; BABA Center, Children's Hospital and Pediatric Research Center, University of Helsinki and HUH, Helsinki, Finland; Neuroscience Center, University of Helsinki, 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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Leikos S, Tokariev A, Koolen N, Nevalainen P, Vanhatalo S. Cortical responses to tactile stimuli in preterm infants. Eur J Neurosci 2019; 51:1059-1073. [PMID: 31679163 DOI: 10.1111/ejn.14613] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/07/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022]
Abstract
The conventional assessment of preterm somatosensory functions using averaged cortical responses to electrical stimulation ignores the characteristic components of preterm somatosensory evoked responses (SERs). Our study aimed to systematically evaluate the occurrence and development of SERs after tactile stimulus in preterm infants. We analysed SERs performed during 45 electroencephalograms (EEGs) from 29 infants at the mean post-menstrual age of 30.7 weeks. Altogether 2,087 SERs were identified visually at single-trial level from unfiltered signals capturing also their slowest components. We observed salient SERs with a high-amplitude slow component at a high success rate after hand (95%) and foot (83%) stimuli. There was a clear developmental change in both the slow wave and the higher-frequency components of the SERs. Infants with intraventricular haemorrhage (IVH; eleven infants) had initially normal SERs, but those with bilateral IVH later showed a developmental decrease in the ipsilateral SER occurrence after 30 weeks of post-menstrual age. Our study shows that tactile stimulus applied at bedside elicits salient SERs with a large slow component and an overriding fast oscillation, which are specific to the preterm period. Prior experimental research indicates that such SERs allow studying both subplate and cortical functions. Our present findings further suggest that they might offer a window to the emergence of neurodevelopmental sequelae after major structural brain lesions and, hence, an additional tool for both research and clinical neurophysiological evaluation of infants before term age.
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Affiliation(s)
- Susanna Leikos
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anton Tokariev
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ninah Koolen
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi Nevalainen
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sampsa Vanhatalo
- Children's Clinical Neurophysiology, BABA Center, Children's Hospital, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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3
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Nevalainen P, Marchi V, Metsäranta M, Lönnqvist T, Vanhatalo S, Lauronen L. Evaluation of SEPs in asphyxiated newborns using a 4-electrode aEEG brain monitoring set-up. Clin Neurophysiol Pract 2018; 3:122-126. [PMID: 30215022 PMCID: PMC6134187 DOI: 10.1016/j.cnp.2018.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/15/2018] [Accepted: 06/15/2018] [Indexed: 11/25/2022] Open
Abstract
Neonatal SEPs can be reliably detected using the 4-electrode aEEG monitoring setup. SEP is discernible in most fullterm newborns with 300 averages. Recording SEPs jointly with aEEG facilitates SEP assessment after birth asphyxia.
Objective To evaluate the reliability of recording cortical somatosensory evoked potentials (SEPs) in asphyxiated newborns using the 4-electrode setup applied in routine long-term amplitude-integrated EEG (aEEG) brain monitoring and to assess the number of averages needed for reliably detecting the cortical responses. Methods We evaluated median nerve SEPs in 50 asphyxiated full-term newborns. The SEP interpretation (present or absent) from the original recordings with 21-electrodes and approximately 600 trials served as the reference. This was compared to SEP classification (absent, present, or unreliable) based on a reduced (300 or 150) number of averages, and to classification based on only four electrodes (F3, P3, F4, P4). Results Compared to the original classification, cortical SEPs were uniformly interpreted as present or absent in all 50 newborns with the 4-electrode setup and 600 averages. Reducing number of averages to 300 still resulted in correct SEP interpretation in 49/50 newborns with 21-electrode setup, and 46/50 newborns with 4-electrode setup. Conclusions Evaluation of early cortical neonatal SEPs is reliable from the 4-electrode setup commonly used in aEEG monitoring. SEP is discernible in most newborns with 300 averages. Significance Adding SEP into routine aEEG monitoring offers an additional tool for early neonatal neurophysiological evaluation.
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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 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
| | - 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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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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Karppinen M, Sjövall A, Pelkonen T, Bernardino L, Roine I, Pitkäranta A, Aarnisalo AA, Nevalainen P, Lauronen L. Prognostic Value and Changes of Auditory Brain Stem Response in Children With Bacterial Meningitis in Luanda, Angola. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2018. [PMID: 29531480 PMCID: PMC5843090 DOI: 10.1177/1179550618758648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess the role of single and repeated auditory brain stem response (ABR) in predicting mortality and severe neurological injury among children having bacterial meningitis (BM) in Luanda, Angola. Methods: The morphology of ABR traces of 221 children (aged 2 months to 12 years) from admission day was analyzed and compared with age-matched normative data. Absence and delay of traces were compared with mortality and mortality or severe neurological injury in subgroup analyses. Outcome was also evaluated with repeated ABR of 166 children based on presence or absence of responses at 80 dB nHL (normal hearing level) stimulation level. Results: Individually, the absence of typical ABR waveform did not signify poor outcome. At the group level, latencies and interpeak latencies (IPLs) were significantly prolonged among patients with BM in comparison with controls, and the prolongation correlated with higher mortality or severe neurological sequelae. Conclusions: We confirmed the effect of BM on neural conduction time in auditory pathway. However, ABR in similar settings seems not useful for individual prognostication, although at the group level, delayed latencies, IPLs, or both associated with poorer outcome.
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Affiliation(s)
- Mariia Karppinen
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Atte Sjövall
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuula Pelkonen
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland.,David Bernardino Children's Hospital, Luanda, Angola
| | | | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | - Anne Pitkäranta
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Otorhinolaryngology, Helsinki University Hospital, Helsinki, Finland
| | - Antti A Aarnisalo
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Otorhinolaryngology, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Nevalainen
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Clinical Neurophysiology and HUS medical imaging centre, Helsinki Finland
| | - Leena Lauronen
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Clinical Neurophysiology and HUS medical imaging centre, Helsinki Finland
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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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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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Elshorbagy HH, Azab AA, Kamal NM, Barseem NF, Bassiouny MM, Elsayed MA, Elkhouly TH. Value of electroencephalographic monitoring in newborns with hypoxic-ischemic encephalopathy treated with hypothermia. J Pediatr Neurosci 2016; 11:309-315. [PMID: 28217152 PMCID: PMC5314843 DOI: 10.4103/1817-1745.199467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The values of electroencephalography (EEG) in neonatal hypoxic-ischemic encephalopathy (HIE) during therapeutic hypothermia (TH) are still uncertain. AIMS 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). PATIENTS AND 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.
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Affiliation(s)
| | - Ahmed A. Azab
- Department of Pediatrics, Benha University, Banha, Egypt
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10
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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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11
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Garfinkle J, Sant'Anna GM, Rosenblatt B, Majnemer A, Wintermark P, Shevell MI. Somatosensory evoked potentials in neonates with hypoxic-ischemic encephalopathy treated with hypothermia. Eur J Paediatr Neurol 2015; 19:423-8. [PMID: 25814390 DOI: 10.1016/j.ejpn.2015.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/24/2015] [Accepted: 03/02/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Somatosensory evoked potentials (SEPs) are reported to have high positive predictive value (PPV) for neurodevelopmental impairment (NDI) in neonates with moderate or severe hypoxic-ischemic encephalopathy (HIE). Our objective was to assess if this predictive value remains high with the use of therapeutic hypothermia. METHODS A cohort of HIE neonates treated with hypothermia was recruited between September 2008 and September 2010. SEPs were elicited after hypothermia and classified as bilateral absent N19, abnormal N19 (i.e., delayed or unilateral absent), or normal. Qualitative evaluation of MRI was also performed. The primary outcome was moderate or severe NDI around 2 years of age. RESULTS SEPs were performed after hypothermia in 26 of 34 neonates submitted to hypothermia with adequate follow-up at a median day of life 11 (IQR 9, 13). Twenty-three (88%) had moderate encephalopathy. Eleven neonates (42%) had bilateral absent N19, 4 of whom had NDI, while fifteen neonates (58%) had either abnormal or normal N19, of whom only one had NDI. SEPs thus had a PPV of 0.36 (4/11) and a negative predictive value (NPV) of 0.93 (14/15). Eighteen neonates (69%) had brain injury on MRI. MRI thus had a PPV of 0.28 (5/18) and an NPV of 1.00 (8/8). CONCLUSIONS Neonates with HIE treated with hypothermia with bilateral absent N19 potentials may have a better prognosis than reported in the pre-hypothermia era. MRI also had a low PPV and high NPV. SEPs should be interpreted with caution in this new population and need to be re-evaluated in larger studies.
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Affiliation(s)
- Jarred Garfinkle
- Departments of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada; Divisions of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada
| | - Guilherme M Sant'Anna
- Departments of Pediatrics, McGill University, Montreal, Quebec, Canada; Divisions of Neonatology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada
| | - Bernard Rosenblatt
- Departments of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada; Departments of Pediatrics, McGill University, Montreal, Quebec, Canada; Divisions of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada
| | - Annette Majnemer
- Departments of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada; Departments of Pediatrics, McGill University, Montreal, Quebec, Canada; Departments of School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada; Divisions of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada
| | - Pia Wintermark
- Departments of Pediatrics, McGill University, Montreal, Quebec, Canada; Divisions of Neonatology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada
| | - Michael I Shevell
- Departments of Neurology/Neurosurgery, McGill University, Montreal, Quebec, Canada; Departments of Pediatrics, McGill University, Montreal, Quebec, Canada; Divisions of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada.
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12
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Julkunen MK, Himanen SL, Eriksson K, Janas M, Luukkaala T, Tammela O. EEG, evoked potentials and pulsed Doppler in asphyxiated term infants. Clin Neurophysiol 2014; 125:1757-63. [PMID: 24534143 DOI: 10.1016/j.clinph.2014.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 01/19/2014] [Accepted: 01/21/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate electroencephalograms (EEG), evoked potentials (EPs) and Doppler findings in the cerebral arteries as predictors of a 1-year outcome in asphyxiated newborn infants. METHODS EEG and EPs (brain stem auditory (BAEP), somatosensory (SEP), visual (VEP) evoked potentials) were assessed in 30 asphyxiated and 30 healthy term infants during the first days (range 1-8). Cerebral blood flow velocities (CBFV) were measured from the cerebral arteries using pulsed Doppler at ∼24h of age. EEG, EPs, Doppler findings, symptoms of hypoxic ischemic encephalopathy (HIE) and their combination were evaluated in predicting a 1-year outcome. RESULTS An abnormal EEG background predicted poor outcome in the asphyxia group with a sensitivity of 67% and 81% specificity, and an abnormal SEP with 75% and 79%, respectively. Combining increased systolic CBFV (mean+3SD) with abnormal EEG or SEP improved the specificity, but not the sensitivity. The predictive values of abnormal BAEP and VEP were poor. Normal EEG and SEP predicted good outcome in the asphyxia group with sensitivities from 79% to 81%. The combination of normal EEG, normal SEP and systolic CBFV<3SD predicted good outcome with a sensitivity of 74% and 100% specificity. CONCLUSIONS Combining abnormal EEG or EPs findings with increased systolic CBFV did not improve prediction of a poor 1-year outcome of asphyxiated infants. Normal EEG and normal SEP combined with systolic CBFV<3SD at about 24 h can be valuable in the prediction of normal 1-year outcome. SIGNIFICANCE Combining systolic CBFV at 24 h with EEG and SEP examinations can be of use in the prediction of normal 1-year outcome among asphyxiated infants.
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Affiliation(s)
- Mia K Julkunen
- Pediatric Research Centre, University of Tampere, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine, University of Tampere, Tampere, Finland
| | - Kai Eriksson
- Pediatric Research Centre, University of Tampere, Tampere, Finland; Pediatric Neurology Unit, Tampere University Hospital, Tampere, Finland
| | - Martti Janas
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Tiina Luukkaala
- Science Center, Pirkanmaa Hospital District, Tampere School of Public Health, University of Tampere, Tampere, Finland
| | - Outi Tammela
- Pediatric Research Centre, University of Tampere, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland
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13
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Kontio T, Toet MC, Hellström-Westas L, van Handel M, Groenendaal F, Stjerna S, Vanhatalo S, de Vries LS. Early neurophysiology and MRI in predicting neurological outcome at 9-10 years after birth asphyxia. Clin Neurophysiol 2013; 124:1089-94. [PMID: 23403266 DOI: 10.1016/j.clinph.2012.12.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 12/18/2012] [Accepted: 12/22/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether early somatosensory evoked potentials (SEP) predict long-term neurodevelopmental outcome in normothermic, full-term infants with mild to moderate neonatal encephalopathy (NE), and to compare their predictive value to already available amplitude integrated EEG (aEEG) and magnetic resonance imaging (MRI). METHODS Fifty-six infants with post-asphyxia NE were prospectively recruited, and their SEP, aEEG and MRI data were acquired during the first five days. Follow-up continued to 9-10 years for assessment of neuromotor and neurocognitive development. We analysed SEP latency (N1 component), normality of aEEG background pattern, as well as patterns of injury on the neonatal MRI. Neurological outcome measures at 9-10 years included conventional MRI, Movement-ABC and the WISC-III NL. RESULTS A SEP latency <50 ms during the first five days was associated with a normal neuromotor outcome (p < 0.03), and a prolonged day 3 latency was associated with lower childhood IQ (p = 0.02). The presence of multiple seizures in aEEG, as well as a moderate or severe injury on the neonatal MRI was associated with a poor neuromotor score (p = 0.03 and p < 0.01, respectively). Combination of multiple techniques improved prediction of long-term outcome compared to single modality. CONCLUSION Early SEPs provide information that is comparable to the already available aEEG and MRI paradigms in the prediction of long-term outcome of full-term infants with mild to moderate neonatal encephalopathy. SIGNIFICANCE The present results call for further studies using early SEP to aid early assessment of infants treated with hypothermia.
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Affiliation(s)
- T Kontio
- Department of Children's Clinical Neurophysiology, Helsinki University Hospital, and Department of Neurological Sciences, University of Helsinki, Finland.
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14
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van Laerhoven H, de Haan TR, Offringa M, Post B, van der Lee JH. Prognostic tests in term neonates with hypoxic-ischemic encephalopathy: a systematic review. Pediatrics 2013; 131:88-98. [PMID: 23248219 DOI: 10.1542/peds.2012-1297] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) after perinatal asphyxia in term neonates causes long-term neurologic sequelae or death. A reliable evidence-based prognosis is essential. The study goal was to investigate the prognostic value of currently used clinical tests in neonatal patients with perinatal asphyxia and HIE. METHODS Searches were made on MEDLINE, Embase, Central, and CINAHL for studies occurring between January 1980 and November 2011. Studies were included if they (1) evaluated outcome in term infants with perinatal asphyxia and HIE, (2) evaluated prognostic tests, and (3) reported outcome at a minimal follow-up age of 18 months. Study selection, assessment of methodologic quality, and data extraction were performed by 3 independent reviewers. Pooled sensitivities and specificities of investigated tests were calculated when possible. RESULTS Of the 259 relevant studies, 29 were included describing 13 prognostic tests conducted 1631 times in 1306 term neonates. A considerable heterogeneity was noted in test performance, cut-off values, and outcome measures. The most promising tests were amplitude-integrated electroencephalography (sensitivity 0.93, [95% confidence interval 0.78-0.98]; specificity 0.90 [0.60-0.98]), EEG (sensitivity 0.92 [0.66-0.99]; specificity 0.83 [0.64-0.93]), and visual evoked potentials (sensitivity 0.90 [0.74-0.97]; specificity 0.92 [0.68-0.98]). In imaging, diffusion weighted MRI performed best on specificity (0.89 [0.62-0.98]) and T1/T2-weighted MRI performed best on sensitivity (0.98 [0.80-1.00]). Magnetic resonance spectroscopy demonstrated a sensitivity of 0.75 (0.26-0.96) with poor specificity (0.58 [0.23-0.87]). CONCLUSIONS This evidence suggests an important role for amplitude-integrated electroencephalography, EEG, visual evoked potentials, and diffusion weighted and conventional MRI. Given the heterogeneity in the tests' performance and outcomes studied, well-designed large prospective studies are needed.
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Affiliation(s)
- Henriette van Laerhoven
- Department of aNeonatology, Emma Children’s Hospital, Academic Medical Center Amsterdam, Netherlands
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15
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Swarte RMC, Cherian PJ, Lequin M, Visser GH, Govaert P. Somatosensory evoked potentials are of additional prognostic value in certain patterns of brain injury in term birth asphyxia. Clin Neurophysiol 2012; 123:1631-8. [PMID: 22264394 DOI: 10.1016/j.clinph.2011.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 12/07/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE (a) To relate MRI patterns of brain injury to somatosensory evoked potentials (SEPs), and (b) to determine the prognostic value of SEPs in addition to continuous EEG monitoring (cEEG) and cerebral imaging, in term asphyxiated newborns. METHODS Fifty one consecutive neonates were studied. Survivors were followed for at least 2 years. cEEG, started within 24h, was done for ≥ 24 h and scored. SEPs and MRIs were performed in the first week. Brain injury patterns were classified. RESULTS Bilaterally abnormal SEPs had a sensitivity of 90% (28/31) and specificity of 85% (17/20) in predicting a poor outcome, defined as death or severe handicap. SEPs were of particular value in predicting outcome in isolated symmetrical white matter injury and predicting the development of hemiparesis in isolated asymmetrical watershed injury. Binary logistic regression analysis revealed a significant relation to outcome separately for cEEG, deep grey matter injury on MRI and SEPs. SEPs provided additional value when added to cEEG and MRI in the model (p=0.034). CONCLUSIONS SEPs are of additional prognostic value after term birth asphyxia. SIGNIFICANCE In certain patterns of postasphyxial neonatal brain injury like asymmetrical watershed lesions and symmetrical white matter injury, EPs are complementary to information obtained from cEEG and MRI for prognostication.
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Affiliation(s)
- Renate M C Swarte
- Department of Neonatology, Erasmus MC-Sophia, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
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16
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Lori S, Bertini G, Molesti E, Gualandi D, Gabbanini S, Bastianelli ME, Pinto F, Dani C. The prognostic role of evoked potentials in neonatal hypoxic-ischemic insult. J Matern Fetal Neonatal Med 2011; 24 Suppl 1:69-71. [DOI: 10.3109/14767058.2011.607661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Mitchell S, James A. Severe late anemia of hemolytic disease of the newborn. Paediatr Child Health 2011; 4:201-3. [PMID: 20212966 DOI: 10.1093/pch/4.3.201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Late anemia is a well-recognized complication of Rhesus hemolytic disease of the newborn (HDN). The incidence of Rhesus HDN is declining, with a tendency for more severely affected pregnancies to be managed in specialist centres. Consequently, many paediatric departments may see relatively few affected infants with comparatively mild disease, and the risk of late anemia in such cases may not always be appreciated. Two cases of infants born with evidence of Rhesus isoimmunization noted at birth and encountering no immediate problems other than mild hyperbilirubinemia are described. After an uneventful early neonatal course, both infants were discharged without follow-up and presented in the second to third weeks of life with severe, life-threatening anemia, leading to neurological sequelae in one case. The importance of close surveillance, including hemoglobin measurements, in all infants with Rhesus hemolytic disease, irrespective of initial severity, is reiterated.
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Affiliation(s)
- S Mitchell
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario
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18
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Perinatal cerebral insults alter auditory event-related potentials. Early Hum Dev 2011; 87:89-95. [PMID: 21144679 DOI: 10.1016/j.earlhumdev.2010.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 10/01/2010] [Accepted: 11/09/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND auditory event-related potentials (AERPs) can be used as indices of neural information processing. Altered AERPs have been reported in children and young adults with frontal lobe infarction. AIM to test the hypothesis that perinatal brain injury affects cortical auditory processing. METHODS we assessed AERPs at term, 6 and 12months of age in preterm infants [n=9, median gestational age (GA) 27.9, range 23.9-30.0wk], term infants with perinatal intracerebral hemorrhage (ICH) [n=5, GA 40.3, range 37.4-42.3wk], and term infants with perinatal asphyxia [n=4, GA 39.4, range 37.9-40.3wk]. Healthy preterm (n=16) and term infants (n=22) served as controls. A harmonic tone of 500-Hz frequency was used as standard and of 750-Hz as deviant stimulus. Mean AERP amplitudes were calculated over 100ms periods from 50 to 350ms. The developmental outcome was followed until 2years of age. RESULTS the term ICH (p=0.012) and asphyxia (p=0.0016) group had smaller or more negative responses to the deviant, resulting in smaller or more negative MMR amplitudes than those of the controls. The preterm ICH group did not differ significantly from their preterm born controls. MMR varied in all patient groups and was not associated with adverse outcome. CONCLUSION AERP alterations suggest that perinatal cerebral insults affect cortical auditory processing.
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19
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Neonatal somatosensory evoked potentials: maturational aspects and prognostic value. Pediatr Neurol 2010; 42:427-33. [PMID: 20472196 DOI: 10.1016/j.pediatrneurol.2009.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/30/2009] [Accepted: 12/21/2009] [Indexed: 10/19/2022]
Abstract
The aim of this prospective study was to evaluate the diagnostic role of somatosensory evoked potentials (SEP) during the neonatal period with regard to maturational changes and prognostic value in perinatal hypoxic-ischemic encephalopathy. Median nerve SEP analysis was performed in 31 healthy infants (group A1, 33-35 weeks, n = 10; group A2, 36-37 weeks, n = 11; group A3, 38-41 weeks, n = 10) and in 10 term infants with hypoxic-ischemic encephalopathy (group B). Cortical latency N1 and central conduction time values were analyzed for group A in relation to postconceptional age and postnatal age and for group B in relation to degree of hypoxic-ischemic encephalopathy and neurodevelopmental outcome (at the mean age of 6.6 + or - 1.6 years). Central latencies were correlated with postconceptional age but not postnatal age. Mean N1 latency and central conduction time values did not differ significantly between groups A1 and A2; the most pronounced decrease was between groups A2 and A3 (postconceptional ages 36-37 vs 38-41 weeks). In group B, central latencies were prolonged, compared with controls (P < 0.001), but were not significantly correlated with long-term outcome in patients with moderate hypoxic-ischemic encephalopathy (n = 6). Neonatal SEP analysis thus is an objective and noninvasive method for assessing functional integrity of the somatosensory pathway. In term infants, SEPs are a valuable additional tool for early diagnosis of hypoxic-ischemic encephalopathy, but are not prognostic of neurodevelopmental long-term outcome in moderate hypoxic-ischemic encephalopathy.
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20
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Cherian PJ, Swarte RM, Visser GH. Technical standards for recording and interpretation of neonatal electroencephalogram in clinical practice. Ann Indian Acad Neurol 2010; 12:58-70. [PMID: 20151016 PMCID: PMC2811985 DOI: 10.4103/0972-2327.48869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 11/13/2008] [Accepted: 11/19/2008] [Indexed: 11/04/2022] Open
Abstract
Neonatal electroencephalogram (EEG), though often perceived as being difficult to record and interpret, is relatively easy to study due to the immature nature of the brain, which expresses only a few well-defined set of patterns. The EEG interpreter needs to be aware of the maturational changes as well as the effect of pathological processes and medication on brain activity. It gives valuable information for the treatment and prognostication in encephalopathic neonates. In this group, serial EEGs or EEG monitoring often gives additional information regarding deterioration/improvement of the brain function or occurrence of seizures.
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Affiliation(s)
- Perumpillichira J Cherian
- Departments of Clinical Neurophysiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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21
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Guérit JM, Amantini A, Amodio P, Andersen K, Butler S, de Weerd A, Facco E, Fischer C, Hantson P, Jäntti V, Lamblin MD, Litscher G, Péréon Y. Consensus on the use of neurophysiological tests in the intensive care unit (ICU): Electroencephalogram (EEG), evoked potentials (EP), and electroneuromyography (ENMG). Neurophysiol Clin 2009; 39:71-83. [DOI: 10.1016/j.neucli.2009.03.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Accepted: 03/28/2009] [Indexed: 10/20/2022] Open
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Pinto ALR, Costa FCS. The value of brainstem evoked potential in clinical decision of a patient with hypoxic-ischemic encephalopathy. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:689-92. [PMID: 17876416 DOI: 10.1590/s0004-282x2007000400028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Accepted: 03/30/2007] [Indexed: 11/22/2022]
Abstract
Establishing a prognosis for hypoxic-ischemic encephalopathy during the neonatal period is extremely difficult, as the neuroplasticity of the developing brain makes it almost impossible to measure the affected area. This case report describes a newborn with severe perinatal asphyxia and neonatal neurological syndrome including absent suck reflex. Normal brainstem auditory evoked potential led the diagnosis towards a transitory dysfunction of deglutition, and the subject received daily stimulation in the hospital environment. Suck developed satisfactorily by day of life 30 and the patient was released without having to be tube fed. Neurophysiologic tests can be of value in the clinical decisions and analysis of functional prognosis of patients with hypoxic-ischemic encephalopathy.
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23
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Abstract
Scalp-recorded somatosensory evoked potentials (SEPs) have been successfully used in neonatal assessment for several decades. The current routine SEP paradigm is markedly predictive for future cerebral palsy (CP) or other neurocognitive sequelae in brain-injured babies. Recent advances in basic science have dramatically increased our knowledge about structural-functional development of SEP-related brain mechanisms. It has thereby become apparent that preterm SEP differs from that in more mature counterparts in that it also comprises responses from transient brain structures, and hence being unique to the preterm period. It is now obvious also that several aspects in the current SEP paradigm, ranging from the type of stimulation to the methods of recording and analysis, are suboptimal for preterm babies. Recent progress in recording and analysis techniques have made it possible to combine SEP studies with EEG recordings, as well as to implement advanced analyses (e.g. time-frequency analysis) into routine practice. This review summarizes literature from relevant areas in basic science, and proposes a novel, integrated approach in neonatal SEP studies in order to significantly increase the fidelity of testing somatosensory system.
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Affiliation(s)
- Sampsa Vanhatalo
- Department of Clinical Neurophysiology, University Hospital of Helsinki, Finland.
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24
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Moon IH, Ha KS, Kim GS, Choi BM, Eun BL, Yoo KH, Hong YS, Lee JW. The auditory evoked potential in premature small for gestational age infants. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.12.1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Il Hong Moon
- Department of Pediatrics, College of Medicine, Korea University Seoul, Korea
| | - Kee Soo Ha
- Department of Pediatrics, College of Medicine, Korea University Seoul, Korea
| | - Gui Sang Kim
- Department of Rehabiliitation Medicine, College of Medicine, Korea University Seoul, Korea
| | - Byung Min Choi
- Department of Pediatrics, College of Medicine, Korea University Seoul, Korea
| | - Baik-Lin Eun
- Department of Pediatrics, College of Medicine, Korea University Seoul, Korea
| | - Kee Hwan Yoo
- Department of Pediatrics, College of Medicine, Korea University Seoul, Korea
| | - Young Sook Hong
- Department of Pediatrics, College of Medicine, Korea University Seoul, Korea
| | - Joo Won Lee
- Department of Pediatrics, College of Medicine, Korea University Seoul, Korea
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25
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Kumar S, Dereddy NR, Bhatia BD, Prakash U. Spinal motor neuron excitability in newborns following fetal distress: sub-clinical depression revealed by soleus H-reflex. Clin Neurophysiol 2005; 116:2342-7. [PMID: 16122978 DOI: 10.1016/j.clinph.2005.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 05/26/2005] [Accepted: 06/08/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore possible spinal cord dysfunction in clinically unaffected newborns emerging from fetal distress, using H-Reflex. METHODS This cross-sectional study comprised 48 full-term newborn infants investigated between 8h and 10 days after birth. Twenty-one (21) had fetal distress defined by late-decelerations in fetal heart rate, out of which 11 had also meconium release in utero; 5 passed meconium in utero with normal FHR patterns; and 22 normal controls had uneventful birth. All had normal birth-weight and Apgar scores. All were found normal on neurological examination, except one showing hypotonia following fetal distress. Soleus H-reflex was studied in right lower limb. RESULTS Newborns delivered with fetal distress showed significant reduction in H-reflex excitability (H/M ratio) within 2 days of birth. Tests performed closer to the birth event revealed more severe depression. Meconium did not contribute to this effect. CONCLUSIONS Fetal distress can lead to transient, subclinical depression of spinal motoneurons in the newborn. SIGNIFICANCE This neonatal H-reflex study focuses on excitability of a spinal motoneuron pool rather than conduction parameters (reflecting myelination) available in literature. It reveals excitability changes missed on clinical examination of newborns apparently unaffected by intrapartum hypoxic-ischemic spells. It also draws attention towards spinal cord dysfunction in birth-hypoxia.
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Affiliation(s)
- Subhankar Kumar
- Department of Physiology, Neurophysiology Research Unit, Institute of Medical Sciences,Banaras Hindu University, Varanasi 221005, India
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26
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Fellman V, Kushnerenko E, Mikkola K, Ceponiene R, Leipala J, Naatanen R. Atypical auditory event-related potentials in preterm infants during the first year of life: a possible sign of cognitive dysfunction? Pediatr Res 2004; 56:291-7. [PMID: 15181180 DOI: 10.1203/01.pdr.0000132750.97066.b9] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We assessed auditory event-related potentials in small-for-gestational-age (SGA; 850 +/- 258 g, 28.9 +/- 3.3 gestational wk; n = 15) and appropriate for gestational age (AGA; 1014 +/- 231 g, 26.9 +/- 1.9 gestational wk; n = 20) preterm infants and healthy term infants (n = 22). An oddball paradigm was used with a harmonic tone of 500-Hz frequency as the standard and of 750-Hz frequency as the deviant stimulus. The preterm infants were studied at 40 gestational wk and at 6 and 12 mo of corrected age, and the control subjects were studied at 2-4 d and at 3, 6, 9, 12, and 15 mo of age. The peaks of interest were the main positive peak (P350), the negative peaks at 250 ms (N250) and 650 ms (Nc), and the mismatch negativity at 200 ms (MMN). At term, the P350 in the preterm infants was similar to that of the newborn control subjects. In response to the deviant, the Nc was smaller in the SGA than in the AGA (P < 0.02) and control (P < 0.005) infants. The N250 amplitude was also lower in the SGA infants. At 12 mo, the MMN was observed in the control but not in the preterm infants, whose broad difference positivity correlated with the Bayley developmental index. The decreased Nc and N250 peaks in the SGA infants may suggest an increased risk for cognitive dysfunction. The broad difference positivity at 1 y of age may indicate atypical cortical auditory processing. Whether cognitive dysfunction can be predicted by these findings needs to be assessed in a study with extended follow-up.
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Affiliation(s)
- Vineta Fellman
- Hospital for Children and Adolescents, Helsinki University Central Hospital, P.O. Box 281, 00029 Helsinki, Finland.
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27
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De Weerd AW. EEG in neonates. What does the neonatal EEG tell about prognosis? SUPPLEMENTS TO CLINICAL NEUROPHYSIOLOGY 2003; 53:243-9. [PMID: 12741006 DOI: 10.1016/s1567-424x(09)70167-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- A W De Weerd
- Department of Clinical Neurophysiology, Center for Sleep and Wake Disorders, Juliana Children Hospital and MCH, Westeinde Hospital, The Hague, The Netherlands.
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28
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Scher M. Perinatal asphyxia: timing and mechanisms of injury in neonatal encephalopathy. Curr Neurol Neurosci Rep 2001; 1:175-84. [PMID: 11898514 DOI: 10.1007/s11910-001-0014-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article summarizes the recent medical literature regarding perinatal asphyxia with respect to timing and mechanisms of injury for neonates who were clinically diagnosed with an encephalopathy in the newborn period. Multiple mechanisms of injury are reviewed, including genetic vulnerability, acquired inflammatory responses, and clotting defects that can lead to ischemic-induced brain damage. Before effective treatments for fetal and neonatal brain disorders can be developed, accurate and timely diagnoses of fetal or neonatal brain injury must be achieved. Specific subsets of children can then benefit from neuroprotective strategies that can target the specific developmental aspects of brain adaptation or plasticity relative to the specific etiology and timing of injury after asphyxia.
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Affiliation(s)
- M Scher
- Division of Pediatrics and Neurology, Rainbow Babies and Children's Hospital, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-6090, USA.
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29
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Majnemer A, Rosenblatt B. Prediction of outcome at school age in neonatal intensive care unit graduates using neonatal neurologic tools. J Child Neurol 2000; 15:645-51. [PMID: 11063077 DOI: 10.1177/088307380001501002] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prediction of outcome for neonatal intensive care unit graduates is clinically useful to counsel families effectively and target those who may benefit from early interventions. Evoked potentials have proven prognostic value of neurologic outcomes in early childhood; however, their long-term predictive validity remains to be determined. The objective of this prospective study was to determine the long-term predictive value of three neonatal neurologic assessments: brainstem auditory evoked potentials, somatosensory evoked potentials, and the Einstein Neonatal Neurobehavioral Assessment Scale. Seventy-eight high-risk newborns and 28 healthy controls were recruited and were assessed in the newborn period using these tests. At 8 to 9 years of age, 42 subjects and 13 controls were re-evaluated for developmental progress using a range of psychologic, sensorimotor, and neurologic measures. Findings indicated that the somatosensory evoked potential was most accurate at predicting outcome at school age, with high specificity (83-100%) across all domains tested and good sensitivity (80-100%) for intellectual performance and sensorimotor abilities. The brainstem auditory evoked potential was limited by false-negatives, whereas the neonatal neurobehavioral assessment yielded many false-positives. This study provides new evidence that associations between neonatal somatosensory evoked potentials and developmental sequelae continue to be significant at school age.
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Affiliation(s)
- A Majnemer
- School of Physical and Occupational Therapy, Department of Neurology, McGill University-Montreal Children's Hospital, PQ, Canada.
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Abstract
The pediatric neurologist is often requested to predict the neurologic outcome in an uncertain situation. A common and problematic clinical setting in which this occurs is the asphyxiated term newborn. This report reviews the predictive tools available for prognostication in this situation and formulates a practical paradigm that the authors hope will improve predictive accuracy and lessen uncertainty in this setting.
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Affiliation(s)
- M I Shevell
- Department of Neurology/Neurosurgery, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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