WIP 02 - Association of Continuous Electroencephalogram Patterns to Outcomes at Discharge in Neonates affected by Hypoxic-Ischemic Encephalopathy undergoing Therapeutic Hypothermia

Publication Number: WIP 02.7527

Gina T. Casini, Baylor College of Medicine, Houston, TX, United States; Julie Plaud Gonzalez, Baylor College of Medicine, Houston, TX, United States; Joseph Hagan, Baylor College of Medicine, Houston, TX, United States; Eli M. Mizrahi, Baylor College of Medicine, Houston, TX, United States; Christopher Rhee, Texas Children's Hospital, Houston, TX, United States

Background: Hypoxic-ischemic encephalopathy (HIE) is the most common cause of neurodevelopmental disability in term infants and is an important source of morbidity and mortality. Therapeutic hypothermia (TH) seeks to limit the amount of secondary cerebral damage that may occur in moderate-to-severe HIE. Continuous electroencephalography (cEEG) plays a leading role in evaluating brain function and seizure burden during TH. Previous studies have shown that a severe degree of cEEG background abnormalities and the degree of seizure burden were associated with poor neurodevelopmental outcomes at 24 months. HIE survivors may go onto experience other comorbidities such as tracheostomy and gastrostomy placement. Early prediction of these comorbidities may assist in discharge planning and coordination of care. However, there is a paucity of data investigating whether cEEG can also be predictive at discharge of these conditions.

Objective: Our study seeks to investigate whether cEEG findings are correlated with specific adverse outcomes at discharge in neonates with moderate-to-severe HIE who underwent TH. We hypothesize that cEEGs with severe background activity, presence of sharp waves, and seizures are associated with increased rates of morbidity and mortality at hospital discharge.

Design/Methods: An IRB-approved retrospective single center cohort study involving a 3-year data period of infants with moderate-to-severe HIE who underwent TH. cEEG was recorded according to technical guidelines of the American Clinical Neurophysiology Society. Daily cEEG clinical interpretations were provided during TH by neurophysiologists trained in neonatal EEG. Retrospectively, each daily cEEG report that described the previous 24-hour period was scored, utilizing a validated methodology to assess: character of the background activity, the presence and location of sharp waves, and seizures. Data will be analyzed by logistic regression to determine if there was an association between cEEG findings and outcomes at discharge. Data analysis is currently in progress with 60 patients enrolled in the study.