Early clinical signs in neonates with hypoxic ischemic encephalopathy predict an abnormal amplitude-integrated electroencephalogram at age 6 hours

BMC Pediatrics

Nicola J Robertson¹  Natasha R Rhoda³  Manigandan Chandrasekaran¹  Michael C Harrison³  Yaseen Joolay³  Moegammad S Raban³  Lucy L Linley³  Landon Myer²  George H Swingler³  Alan R Horn³ 

[1] Institute for Women’s Health, University College London, Huntley St, London, UK;School of Public Health and Family Medicine, Falmouth Building, University of Cape Town, Anzio Rd, Observatory, Cape Town, South Africa;School of Child and Adolescent Health, University of Cape Town, Red Cross War Memorial Children’s Hospital, Klipfontein Rd, Cape Town, South Africa

关键词: Prognostic;    aEEG;    Electroencephalogram;    Hypoxic ischemic encephalopathy;    Neonate;    Asphyxia;   

Others  :  1145015
DOI  :  10.1186/1471-2431-13-52

 received in 2013-01-12, accepted in 2013-04-01,  发布年份 2013

【 摘 要 】

Background

An early clinical score predicting an abnormal amplitude-integrated electroencephalogram (aEEG) or moderate-severe hypoxic ischemic encephalopathy (HIE) may allow rapid triage of infants for therapeutic hypothermia. We aimed to determine if early clinical examination could predict either an abnormal aEEG at age 6 hours or moderate-severe HIE presenting within 72 hours of birth.

Methods

Sixty infants ≥ 36 weeks gestational age were prospectively enrolled following suspected intrapartum hypoxia and signs of encephalopathy. Infants who were moribund, had congenital conditions that could contribute to the encephalopathy or had severe cardio-respiratory instability were excluded. Predictive values of the Thompson HIE score, modified Sarnat encephalopathy grade (MSEG) and specific individual signs at age 3–5 hours were calculated.

Results

All of the 60 infants recruited had at least one abnormal primitive reflex. Visible seizures and hypotonia at 3–5 hours were strongly associated with an abnormal 6-hour aEEG (specificity 88% and 92%, respectively), but both had a low sensitivity (47% and 33%, respectively). Overall, 52% of the infants without hypotonia at 3–5 hours had an abnormal 6-hour aEEG. Twelve of the 29 infants (41%) without decreased level of consciousness at 3–5 hours had an abnormal 6-hour aEEG (sensitivity 67%; specificity 71%). A Thompson score ≥ 7 and moderate-severe MSEG at 3–5 hours, both predicted an abnormal 6-hour aEEG (sensitivity 100 vs. 97% and specificity 67 vs. 71% respectively). Both assessments predicted moderate-severe encephalopathy within 72 hours after birth (sensitivity 90%, vs. 88%, specificity 92% vs. 100%). The 6-hour aEEG predicted moderate-severe encephalopathy within 72 hours (sensitivity 75%, specificity 100%) but with lower sensitivity (p = 0.0156) than the Thompson score (sensitivity 90%, specificity 92%). However, all infants with a normal 3- and 6-hour aEEG with moderate-severe encephalopathy within 72 hours who were not cooled had a normal 24-hour aEEG.

Conclusions

The encephalopathy assessment described by the Thompson score at age 3–5 hours is a sensitive predictor of either an abnormal 6-hour aEEG or moderate-severe encephalopathy presenting within 72 hours after birth. An early Thompson score may be useful to assist with triage and selection of infants for therapeutic hypothermia.

【 授权许可】

   
2013 Horn et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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