Early predictors of short term neurodevelopmental outcome in asphyxiated cooled infants. A combined brain amplitude integrated electroencephalography and near infrared spectroscopy study

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• 作者：Gina Ancora ; ^{Gina.Ancora@auslrn.net} ; Eugenia Maranella ; Sara Grandi ; Francesca Sbravati ; Elena Coccolini ; Silvia Savini ; Giacomo Faldella
• 关键词：Hypoxic-ischemic encephalopathy ; Amplitude integrated electroencephalography ; Near infrared spectroscopy ; Hypothermia ; Tissue oxygenation index
• 刊名：Brain and Development
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：35
• 期：1
• 页码：26-31
• 全文大小：182 K

文摘

Background: Brain Cooling (BC) represents the elective treatment in asphyxiated newborns. Amplitude Integrated Electroencephalography (aEEG) and Near Infrared Spectroscopy (NIRS) monitoring may help to evaluate changes in cerebral electrical activity and cerebral hemodynamics during hypothermia. Objectives: To evaluate the prognostic value of aEEG time course and NIRS data in asphyxiated cooled infants. Methods: Twelve term neonates admitted to our NICU with moderate-severe Hypoxic-Ischemic Encephalopathy (HIE) underwent selective BC. aEEG and NIRS monitoring were started as soon as possible and maintained during the whole hypothermic treatment. Follow-up was scheduled at regular intervals; adverse outcome was defined as death, cerebral palsy (CP) or global quotient <88.7 at Griffiths¡¯ Scale. Results: 2/12 Infants died, 2 developed CP, 1 was normal at 6 months of age and then lost at follow-up and 7 showed a normal outcome at least at 1 year of age. The aEEG background pattern at 24 h of life was abnormal in 10 newborns; only 4 of them developed an adverse outcome, whereas the 2 infants with a normal aEEG developed normally. In infants with adverse outcome NIRS showed a higher Tissue Oxygenation Index (TOI) than those with normal outcome (80.0 ¡À 10.5 % vs 66.9 ¡À 7.0 % , p = 0.057; 79.7 ¡À 9.4 % vs 67.1 ¡À 7.9 % , p = 0.034; 80.2 ¡À 8.8 % vs 71.6 ¡À 5.9 % , p = 0.069 at 6, 12 and 24 h of life, respectively). Conclusions: The aEEG background pattern at 24 h of life loses its positive predictive value after BC implementation; TOI could be useful to predict early on infants that may benefit from other innovative therapies.