Predictive value of an early amplitude integrated electroencephalogram and neurologic examination

Seetha Shankaran, Athina Pappas, Scott A. McDonald, Abbot R. Laptook, Rebecca Bara, Richard A. Ehrenkranz, Jon E. Tyson, Ronald Goldberg, Edward F. Donovan, Avroy A. Fanaroff, Abhik Das, W. Kenneth Poole, Michele Walsh, Rosemary D. Higgins, Cherie Welsh, Walid Salhab, Waldemar A. Carlo, Brenda Poindexter, Barbara J. Stoll, Ronnie Guillet & 3 others Neil N. Finer, David K. Stevenson, Charles R. Bauer

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

OBJECTIVE: To examine the predictive validity of the amplitude integrated electroencephalogram (aEEG) and stage of encephalopathy among infants with hypoxic-ischemic encephalopathy (HIE) eligible for therapeutic whole-body hypothermia. DESIGN: Neonates were eligible for this prospective study if moderate or severe HIE occurred at <6 hours and an aEEG was obtained at <9 hours of age. The primary outcome was death or moderate/severe disability at 18 months. RESULTS: There were 108 infants (71 with moderate HIE and 37 with severe HIE) enrolled in the study. aEEG findings were categorized as normal, with continuous normal voltage (n = 12) or discontinuous normal voltage (n = 12), or abnormal, with burst suppression (n = 22), continuous low voltage (n = 26), or flat tracing (n = 36). At 18 months, 53 infants (49%) experienced death or disability. Severe HIE and an abnormal aEEG were related to the primary outcome with univariate analysis, whereas severe HIE alone was predictive of outcome with multivariate analysis. Addition of aEEG pattern to HIE stage did not add to the predictive value of the model; the area under the curve changed from 0.72 to 0.75 (P = .19). CONCLUSIONS: The aEEG background pattern did not significantly enhance the value of the stage of encephalopathy at study entry in predicting death and disability among infants with HIE.

Original languageEnglish
JournalPediatrics
Volume128
Issue number1
DOIs
StatePublished - Jul 2011

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Brain Hypoxia-Ischemia
Neurologic Examination
Electroencephalography
Brain Diseases
Hypothermia
Area Under Curve
Multivariate Analysis
Newborn Infant
Prospective Studies

Keywords

  • Amplitude integrated EEG
  • Neonatal hypoxic-ischemic encephalopathy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Shankaran, S., Pappas, A., McDonald, S. A., Laptook, A. R., Bara, R., Ehrenkranz, R. A., ... Bauer, C. R. (2011). Predictive value of an early amplitude integrated electroencephalogram and neurologic examination. Pediatrics, 128(1). https://doi.org/10.1542/peds.2010-2036

Predictive value of an early amplitude integrated electroencephalogram and neurologic examination. / Shankaran, Seetha; Pappas, Athina; McDonald, Scott A.; Laptook, Abbot R.; Bara, Rebecca; Ehrenkranz, Richard A.; Tyson, Jon E.; Goldberg, Ronald; Donovan, Edward F.; Fanaroff, Avroy A.; Das, Abhik; Poole, W. Kenneth; Walsh, Michele; Higgins, Rosemary D.; Welsh, Cherie; Salhab, Walid; Carlo, Waldemar A.; Poindexter, Brenda; Stoll, Barbara J.; Guillet, Ronnie; Finer, Neil N.; Stevenson, David K.; Bauer, Charles R.

In: Pediatrics, Vol. 128, No. 1, 07.2011.

Research output: Contribution to journalArticle

Shankaran, S, Pappas, A, McDonald, SA, Laptook, AR, Bara, R, Ehrenkranz, RA, Tyson, JE, Goldberg, R, Donovan, EF, Fanaroff, AA, Das, A, Poole, WK, Walsh, M, Higgins, RD, Welsh, C, Salhab, W, Carlo, WA, Poindexter, B, Stoll, BJ, Guillet, R, Finer, NN, Stevenson, DK & Bauer, CR 2011, 'Predictive value of an early amplitude integrated electroencephalogram and neurologic examination', Pediatrics, vol. 128, no. 1. https://doi.org/10.1542/peds.2010-2036
Shankaran S, Pappas A, McDonald SA, Laptook AR, Bara R, Ehrenkranz RA et al. Predictive value of an early amplitude integrated electroencephalogram and neurologic examination. Pediatrics. 2011 Jul;128(1). https://doi.org/10.1542/peds.2010-2036
Shankaran, Seetha ; Pappas, Athina ; McDonald, Scott A. ; Laptook, Abbot R. ; Bara, Rebecca ; Ehrenkranz, Richard A. ; Tyson, Jon E. ; Goldberg, Ronald ; Donovan, Edward F. ; Fanaroff, Avroy A. ; Das, Abhik ; Poole, W. Kenneth ; Walsh, Michele ; Higgins, Rosemary D. ; Welsh, Cherie ; Salhab, Walid ; Carlo, Waldemar A. ; Poindexter, Brenda ; Stoll, Barbara J. ; Guillet, Ronnie ; Finer, Neil N. ; Stevenson, David K. ; Bauer, Charles R. / Predictive value of an early amplitude integrated electroencephalogram and neurologic examination. In: Pediatrics. 2011 ; Vol. 128, No. 1.
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AU - Ehrenkranz, Richard A.

AU - Tyson, Jon E.

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AU - Donovan, Edward F.

AU - Fanaroff, Avroy A.

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AU - Poole, W. Kenneth

AU - Walsh, Michele

AU - Higgins, Rosemary D.

AU - Welsh, Cherie

AU - Salhab, Walid

AU - Carlo, Waldemar A.

AU - Poindexter, Brenda

AU - Stoll, Barbara J.

AU - Guillet, Ronnie

AU - Finer, Neil N.

AU - Stevenson, David K.

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N2 - OBJECTIVE: To examine the predictive validity of the amplitude integrated electroencephalogram (aEEG) and stage of encephalopathy among infants with hypoxic-ischemic encephalopathy (HIE) eligible for therapeutic whole-body hypothermia. DESIGN: Neonates were eligible for this prospective study if moderate or severe HIE occurred at <6 hours and an aEEG was obtained at <9 hours of age. The primary outcome was death or moderate/severe disability at 18 months. RESULTS: There were 108 infants (71 with moderate HIE and 37 with severe HIE) enrolled in the study. aEEG findings were categorized as normal, with continuous normal voltage (n = 12) or discontinuous normal voltage (n = 12), or abnormal, with burst suppression (n = 22), continuous low voltage (n = 26), or flat tracing (n = 36). At 18 months, 53 infants (49%) experienced death or disability. Severe HIE and an abnormal aEEG were related to the primary outcome with univariate analysis, whereas severe HIE alone was predictive of outcome with multivariate analysis. Addition of aEEG pattern to HIE stage did not add to the predictive value of the model; the area under the curve changed from 0.72 to 0.75 (P = .19). CONCLUSIONS: The aEEG background pattern did not significantly enhance the value of the stage of encephalopathy at study entry in predicting death and disability among infants with HIE.

AB - OBJECTIVE: To examine the predictive validity of the amplitude integrated electroencephalogram (aEEG) and stage of encephalopathy among infants with hypoxic-ischemic encephalopathy (HIE) eligible for therapeutic whole-body hypothermia. DESIGN: Neonates were eligible for this prospective study if moderate or severe HIE occurred at <6 hours and an aEEG was obtained at <9 hours of age. The primary outcome was death or moderate/severe disability at 18 months. RESULTS: There were 108 infants (71 with moderate HIE and 37 with severe HIE) enrolled in the study. aEEG findings were categorized as normal, with continuous normal voltage (n = 12) or discontinuous normal voltage (n = 12), or abnormal, with burst suppression (n = 22), continuous low voltage (n = 26), or flat tracing (n = 36). At 18 months, 53 infants (49%) experienced death or disability. Severe HIE and an abnormal aEEG were related to the primary outcome with univariate analysis, whereas severe HIE alone was predictive of outcome with multivariate analysis. Addition of aEEG pattern to HIE stage did not add to the predictive value of the model; the area under the curve changed from 0.72 to 0.75 (P = .19). CONCLUSIONS: The aEEG background pattern did not significantly enhance the value of the stage of encephalopathy at study entry in predicting death and disability among infants with HIE.

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