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Abstract
Objective: To assess the risk factors for electrographic seizures among neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE).
Methods: Three-center observational cohort study of 90 term neonates treated with hypothermia, monitored with continuous video-EEG (cEEG) within the first day of life (median age at onset of recording 9.5 hours, interquartile range 6.3–14.5), and continued for >24 hours (total recording 93.3 hours, interquartile range 80.1–112.8 among survivors). A pediatric electroencephalographer at each site reviewed cEEGs for electrographic seizures and initial EEG background category.
Results: A total of 43 (48%) had electrographic seizures, including 9 (10%) with electrographic status epilepticus. Abnormal initial EEG background classification (excessively discontinuous, depressed and undifferentiated, burst suppression, or extremely low voltage), but not clinical variables (including pH <6.8, base excess ≤−20, or 10-minute Apgar ≤3), was strongly associated with seizures.
Conclusions: Electrographic seizures are common among neonates with HIE undergoing hypothermia and are difficult to predict based on clinical features. These results justify the recommendation for cEEG monitoring in neonates treated with hypothermia.
GLOSSARY
- ACNS=
- American Clinical Neurophysiology Society;
- aEEG=
- amplitude-integrated EEG;
- cEEG=
- continuous video-EEG;
- HIE=
- hypoxic-ischemic encephalopathy
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 1200
- Received July 23, 2013.
- Accepted in final form November 18, 2013.
- © 2014 American Academy of Neurology
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- EEG monitoring for seizure diagnosis
- EEG and neonatal hypothermia
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