Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes
Licia Lugli,
Isotta Guidotti,
Marisa Pugliese,
Maria Federica Roversi,
Luca Bedetti,
Elisa Della Casa Muttini,
Francesca Cavalleri,
Alessandra Todeschini,
Maurilio Genovese,
Luca Ori,
Maria Amato,
Francesca Miselli,
Laura Lucaccioni,
Natascia Bertoncelli,
Francesco Candia,
Tommaso Maura,
Lorenzo Iughetti,
Fabrizio Ferrari,
Alberto Berardi
Affiliations
Licia Lugli
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Isotta Guidotti
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Marisa Pugliese
Psychology Unit, University Hospital of Modena, 41100 Modena, Italy
Maria Federica Roversi
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Luca Bedetti
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Elisa Della Casa Muttini
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Francesca Cavalleri
Neuroradiology Unit, University Hospital of Modena, 41100 Modena, Italy
Alessandra Todeschini
Neuroradiology Unit, University Hospital of Modena, 41100 Modena, Italy
Maurilio Genovese
Neuroradiology Unit, University Hospital of Modena, 41100 Modena, Italy
Luca Ori
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Maria Amato
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Francesca Miselli
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Laura Lucaccioni
Pediatric Unit, Mother-Child Department, University Hospital of Modena, 41100 Modena, Italy
Natascia Bertoncelli
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Francesco Candia
Postgraduate School of Pediatrics, Department of Medical and Surgical Sciences for Mother, Children and Adults, University of Modena and Reggio Emilia, 41100 Modena, Italy
Tommaso Maura
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Lorenzo Iughetti
Pediatric Unit, Mother-Child Department, University Hospital of Modena, 41100 Modena, Italy
Fabrizio Ferrari
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Alberto Berardi
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
Background: Neonatal encephalopathy due to perinatal asphyxia is one of the leading causes of neonatal death and morbidity worldwide. The neurodevelopmental outcomes of asphyxiated neonates have considerably improved after therapeutic hypothermia (TH). The current challenge is to identify all newborns with encephalopathy at risk of cerebral lesions and subsequent disability within 6 h of life and who may be within the window period for treatment with TH. This study evaluated the neurodevelopmental outcomes in surviving asphyxiated neonates who did and did not receive TH, based on clinical and polygraphic electroencephalographic (p-EEG) criteria. Methods: The study included 139 asphyxiated newborns divided into two groups: 82 who received TH and 57 who were not cooled. TH was administered to asphyxiated newborns (gestational age ≥ 35 weeks, birth weight ≥ 1800 g) with encephalopathy of any grade and moderate-to-severe p-EEG abnormalities or seizures. Neurodevelopmental outcomes between the groups at 24 months of life and the risk factors for severe outcomes were assessed. Results: Severe neurodevelopmental impairment occurred in 10 (7.2%) out of the 139 enrolled neonates. Nine out of the 82 cooled neonates (11.0%) had severe neurodevelopmental impairment. All but one neonate (98.2%) who did not receive TH had normal outcomes. The multivariate logistic regression analysis showed that abnormal p-EEG patterns (OR: 27.6; IC: 2.8–267.6) and general movements (OR: 3.2; IC: 1.0–10.0) were significantly associated with severe neurodevelopmental impairment (area under ROC curve: 92.7%). Conclusion: The combination of clinical and p-EEG evaluations in hypoxic–ischemic encephalopathy contributed to a more accurate selection of patients treated with therapeutic hypothermia. When administered to infants with moderate to severe p-EEG abnormalities, TH prevents approximately 90% of severe neurodevelopmental impairment after any grade of hypoxic–ischemic encephalopathy.
