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Association of cerebral activity with MRI scans in infants with neonatal encephalopathy undergoing therapeutic hypothermia

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Abstract

We aimed to correlate amplitude-integrated EEG (aEEG) in neonatal hypoxic ischemic encephalopathy (HIE) with early magnetic resonance imaging (MRI). In this retrospective study, 32 neonates over 35 weeks’ gestation with moderate/severe HIE who were treated with hypothermia were included. Early MRI scans and daily aEEG background were categorized to mild/normal, moderate, and severely abnormal. Time to sleep cycling was noted on aEEG. Mantel-Haenszel test for trends was used to explore associations between aEEG and MRI and outcome. LOESS regression was used for exploring the association of cycling with MRI scores. MRI was normal/mildly abnormal in 20 (63%) infants; in 9 (28%), moderately abnormal; and in 3 (9%), severely abnormal. Twenty-seven (84%) infants s urvived. MRI severity score was significantly associated with aEEG background score on the third and fourth days of life (p < 0.01). An increase in the MRI severity score was noted if sleep cycling appeared after the fifth day of life.

Conclusions: Depressed aEEG at the third and fourth days of life and appearance of cycling beyond the fifth day of life are associated with cerebral MRI abnormalities and may be associated with increased risk of abnormal outcome.

What is known:

• Since therapeutic hypothermia has been shown to change long-term outcome, amplitude-integrated EEG in infants with hypoxic ischemic neonatal encephalopathy soon after birth have a limited predictive power for long-term outcome in treated infants.

• Brain MRI after therapeutic hypothermia in the above infants has a significant predictive value for long-term outcome

What is new:

• Background amplitude-integrated EEG activity depression at the age of 3 and 4 days and delay of appearance of cycling activity are associated with worse MRI scores and may be predictive of worse long-term outcome

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Abbreviations

aEEG:

Amplitude-integrated electroencephalography

CP:

Cerebral palsy

HIE:

Hypoxic ischemic encephalopathy

MRI:

Magnetic resonance imaging

NICU:

Neonatal intensive care unit

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Acknowledgements

We wish to thank Dr. Kyla Marks for reviewing the final version of the manuscript.

Funding

The study was supported by an internal Clinical Center Grant of the Soroka University Medical Center.

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Authors and Affiliations

  1. Neonatology Department, Soroka Medical Center, Rager Ave 151, 84101, Be’er Sheva, Israel

    Eilon Shany & Irina Meledin

  2. Faculty of Health sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel

    Eilon Shany, Ela Benkovich, Rosa Novoa, Irina Meledin, Amarilla Mandola, Victor Novack & Ilan Shelef

  3. Pediatrics Division, Soroka Medical Center, Be’er Sheva, Israel

    Nasrin Taha & Amarilla Mandola

  4. Radiology Department, Soroka Medical Center, Be’er Sheva, Israel

    Ela Benkovich, Rosa Novoa & Ilan Shelef

  5. Clinical Research Center, Soroka Medical Center, Be’er Sheva, Israel

    Victor Novack

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  1. Eilon Shany
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Contributions

Eilon Shany: Original conception and design of the study, data acquisition, analysis and interpretation of data, wrote the first draft of the manuscript, and approved the final version. Nasrin Taha: Design of the study, data acquisition, and critical review of the manuscript and its final approval. Ela Benkovich: Design of the study, data acquisition and interpretation, and critical review of the manuscript and its final approval. Rosa Novoa: Design of the study, data acquisition and interpretation, and critical review of the manuscript and its final approval. Irina Meledin: Design of the study, data acquisition and interpretation, and critical review of the manuscript and its final approval. Amarilla Mandola: Original conception and design of the study, data acquisition, and critical review of the manuscript and its final approval. Victor Novack: Design of the study, data acquisition and analysis (including statistical review), and critical review of the manuscript and its final approval. Ilan Shelef: Original conception and design of the study, data acquisition and interpretation, and critical review of the manuscript and its final approval.

Corresponding author

Correspondence to Eilon Shany.

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Conflict of interest

All authors either worked or are currently working in Soroka University Medical center.

Ethical approval

The study was approved by the local ethics committee of Soroka Medical Center. As this was a retrospective study, informed consent was waived.

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Communicated by Patrick Van Reempts

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Shany, E., Taha, N., Benkovich, E. et al. Association of cerebral activity with MRI scans in infants with neonatal encephalopathy undergoing therapeutic hypothermia. Eur J Pediatr 178, 851–861 (2019). https://doi.org/10.1007/s00431-019-03364-1

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  • DOI: https://doi.org/10.1007/s00431-019-03364-1

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