Longitudinal Analysis of Amplitude-Integrated Electroencephalography for Outcome Prediction in Hypoxic-Ischemic Encephalopathy - 22/06/22
Abstract |
Objective |
To investigate the prognostic accuracy of longitudinal analysis of amplitude-integrated electroencephalography (aEEG) background activity to predict long-term neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia.
Study design |
This single-center observational study included 149 neonates for derivation and 55 neonates for validation with moderate-severe HIE and of gestational age ≥35 weeks at a tertiary neonatal intensive care unit. Single-channel aEEG background pattern, sleep-wake cycling, and seizure activity were monitored over 84 hours during therapeutic hypothermia and rewarming, then scored for each 6-hour interval. Neurodevelopmental outcome was assessed using the Bayley Scales of Infant Development, Second Edition. Favorable outcome was defined as having both a Mental Development Index (MDI) score and Psychomotor Development Index (PDI) score ≥70, and adverse outcome was defined as either an MDI or a PDI <70 or death. Regression modeling for longitudinal analysis of repeatedly measured data was applied, and area under the receiver operating characteristic curve (AUC) was calculated.
Results |
Longitudinal aEEG background analysis combined with sleep-wake cycling score had excellent predictive value (AUC, 0.90; 95% CI, 0.85-0.95), better than single aEEG scores at any individual time point. The model performed well in the independent validation cohort (AUC, 0.87; 95% CI, 0.62-1.00). The reclassification rate of this model compared with the conventional analysis of aEEG background at 48 hours was 18% (24 patients); 14% (18 patients) were reclassified correctly. Our results were used to develop a user-friendly online outcome prediction tool.
Conclusions |
Longitudinal analysis of aEEG background activity and sleep-wake cycling is a valuable and accurate prognostic tool.
Le texte complet de cet article est disponible en PDF.Keywords : amplitude-integrated electroencephalography, asphyxia, newborn, brain function, sleep-wake cycling, seizure, therapeutic hypothermia, score
Abbreviations : aEEG, AUC, CNV, DNV, HIE, MDI, MRI, PDI
Plan
| U.M. and A.J. were supported by the Ministry for Innovation and Technology of Hungary through the National Research, Development and Innovation Fund (TKP2021-EGA25). The authors have no conflicts of interest to disclose. |
Vol 246
P. 19 - juillet 2022 Retour au numéro
Article précédent
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