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Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes

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 newbor...

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Autores principales: Lugli, Licia, Guidotti, Isotta, Pugliese, Marisa, Roversi, Maria Federica, Bedetti, Luca, Della Casa Muttini, Elisa, Cavalleri, Francesca, Todeschini, Alessandra, Genovese, Maurilio, Ori, Luca, Amato, Maria, Miselli, Francesca, Lucaccioni, Laura, Bertoncelli, Natascia, Candia, Francesco, Maura, Tommaso, Iughetti, Lorenzo, Ferrari, Fabrizio, Berardi, Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9406624/
https://www.ncbi.nlm.nih.gov/pubmed/36010084
http://dx.doi.org/10.3390/children9081194
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author Lugli, Licia
Guidotti, Isotta
Pugliese, Marisa
Roversi, Maria Federica
Bedetti, Luca
Della Casa Muttini, Elisa
Cavalleri, Francesca
Todeschini, Alessandra
Genovese, Maurilio
Ori, Luca
Amato, Maria
Miselli, Francesca
Lucaccioni, Laura
Bertoncelli, Natascia
Candia, Francesco
Maura, Tommaso
Iughetti, Lorenzo
Ferrari, Fabrizio
Berardi, Alberto
author_facet Lugli, Licia
Guidotti, Isotta
Pugliese, Marisa
Roversi, Maria Federica
Bedetti, Luca
Della Casa Muttini, Elisa
Cavalleri, Francesca
Todeschini, Alessandra
Genovese, Maurilio
Ori, Luca
Amato, Maria
Miselli, Francesca
Lucaccioni, Laura
Bertoncelli, Natascia
Candia, Francesco
Maura, Tommaso
Iughetti, Lorenzo
Ferrari, Fabrizio
Berardi, Alberto
author_sort Lugli, Licia
collection PubMed
description 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.
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spelling pubmed-94066242022-08-26 Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes Lugli, Licia Guidotti, Isotta Pugliese, Marisa Roversi, Maria Federica Bedetti, Luca Della Casa Muttini, Elisa Cavalleri, Francesca Todeschini, Alessandra Genovese, Maurilio Ori, Luca Amato, Maria Miselli, Francesca Lucaccioni, Laura Bertoncelli, Natascia Candia, Francesco Maura, Tommaso Iughetti, Lorenzo Ferrari, Fabrizio Berardi, Alberto Children (Basel) Article 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. MDPI 2022-08-09 /pmc/articles/PMC9406624/ /pubmed/36010084 http://dx.doi.org/10.3390/children9081194 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lugli, Licia
Guidotti, Isotta
Pugliese, Marisa
Roversi, Maria Federica
Bedetti, Luca
Della Casa Muttini, Elisa
Cavalleri, Francesca
Todeschini, Alessandra
Genovese, Maurilio
Ori, Luca
Amato, Maria
Miselli, Francesca
Lucaccioni, Laura
Bertoncelli, Natascia
Candia, Francesco
Maura, Tommaso
Iughetti, Lorenzo
Ferrari, Fabrizio
Berardi, Alberto
Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes
title Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes
title_full Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes
title_fullStr Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes
title_full_unstemmed Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes
title_short Polygraphic EEG Can Identify Asphyxiated Infants for Therapeutic Hypothermia and Predict Neurodevelopmental Outcomes
title_sort polygraphic eeg can identify asphyxiated infants for therapeutic hypothermia and predict neurodevelopmental outcomes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9406624/
https://www.ncbi.nlm.nih.gov/pubmed/36010084
http://dx.doi.org/10.3390/children9081194
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