TY - JOUR
T1 - Therapeutic hypothermia in neonatal hypoxic ischemic encephalopathy
T2 - Electrographic seizures and magnetic resonance imaging evidence of injury
AU - Srinivasakumar, Preethi
AU - Zempel, John
AU - Wallendorf, Michael
AU - Lawrence, Russell
AU - Inder, Terrie
AU - Mathur, Amit
PY - 2013/8
Y1 - 2013/8
N2 - Objective: To evaluate the electrographic seizure burden in neonates with hypoxic ischemic encephalopathy (HIE) treated with or without therapeutic hypothermia and stratified results by severity of HIE and severity of injury as assessed by magnetic resonance imaging (MRI). Study design: Between 2007 and 2011, video-electroencephalography (EEG) monitoring was initiated in neonates with moderate to severe HIE. Seizure burden (in seconds) was calculated, and brain MRI scans were quantitatively scored. Data were analyzed by ANOVA, the Student t test, and the χ2 test. Results: Sixty-nine neonates with moderate or severe HIE were prospectively enrolled, including 51 who received therapeutic hypothermia and 18 who did not. The mean duration of video-EEG monitoring was longer in the therapeutic hypothermia group (72 ± 34 hours vs 48 ± 34 hours; P =.01). The therapeutic hypothermia group had a lower electrographic seizure burden (log units) after controlling for injury, as assessed by MRI (2.9 ± 0.6 vs 6.2 ± 0.9; P =.003). A reduction in seizure burden was seen in neonates with moderate HIE (P =.0001), but not in those with severe HIE (P =.80). Among neonates with injury assessed by MRI, seizure burden was lower in those with mild (P =.0004) and moderate (P =.02) injury, but not in those with severe injury (P =.90). Conclusion: Therapeutic hypothermia was associated with reduced electrographic seizure burden in neonatal HIE. This effect was detected on video-EEG in infants with moderate HIE, but not in those with severe HIE. When stratified by injury as assessed by MRI, therapeutic hypothermia was associated with a reduced seizure burden in infants with mild and moderate injury, but not in those with severe injury.
AB - Objective: To evaluate the electrographic seizure burden in neonates with hypoxic ischemic encephalopathy (HIE) treated with or without therapeutic hypothermia and stratified results by severity of HIE and severity of injury as assessed by magnetic resonance imaging (MRI). Study design: Between 2007 and 2011, video-electroencephalography (EEG) monitoring was initiated in neonates with moderate to severe HIE. Seizure burden (in seconds) was calculated, and brain MRI scans were quantitatively scored. Data were analyzed by ANOVA, the Student t test, and the χ2 test. Results: Sixty-nine neonates with moderate or severe HIE were prospectively enrolled, including 51 who received therapeutic hypothermia and 18 who did not. The mean duration of video-EEG monitoring was longer in the therapeutic hypothermia group (72 ± 34 hours vs 48 ± 34 hours; P =.01). The therapeutic hypothermia group had a lower electrographic seizure burden (log units) after controlling for injury, as assessed by MRI (2.9 ± 0.6 vs 6.2 ± 0.9; P =.003). A reduction in seizure burden was seen in neonates with moderate HIE (P =.0001), but not in those with severe HIE (P =.80). Among neonates with injury assessed by MRI, seizure burden was lower in those with mild (P =.0004) and moderate (P =.02) injury, but not in those with severe injury (P =.90). Conclusion: Therapeutic hypothermia was associated with reduced electrographic seizure burden in neonatal HIE. This effect was detected on video-EEG in infants with moderate HIE, but not in those with severe HIE. When stratified by injury as assessed by MRI, therapeutic hypothermia was associated with a reduced seizure burden in infants with mild and moderate injury, but not in those with severe injury.
KW - Amplitude-integrated electroencephalography
KW - EEG
KW - Electroencephalography
KW - HIE
KW - Hypoxic ischemic encephalopathy
KW - MRI
KW - Magnetic resonance imaging
KW - aEEG
UR - http://www.scopus.com/inward/record.url?scp=84880603582&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2013.01.041
DO - 10.1016/j.jpeds.2013.01.041
M3 - Article
C2 - 23452588
AN - SCOPUS:84880603582
SN - 0022-3476
VL - 163
SP - 465
EP - 470
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 2
ER -