Therapeutic hypothermia in neonatal hypoxic ischemic encephalopathy: Electrographic seizures and magnetic resonance imaging evidence of injury

Preethi Srinivasakumar, John Zempel, Michael Wallendorf, Russell Lawrence, Terrie Inder, Amit Mathur

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Objective: To evaluate the electrographic seizure burden in neonates with hypoxic ischemic encephalopathy (HIE) treated with or without therapeutic hypothermia and stratified results by severity of HIE and severity of injury as assessed by magnetic resonance imaging (MRI). Study design: Between 2007 and 2011, video-electroencephalography (EEG) monitoring was initiated in neonates with moderate to severe HIE. Seizure burden (in seconds) was calculated, and brain MRI scans were quantitatively scored. Data were analyzed by ANOVA, the Student t test, and the χ2 test. Results: Sixty-nine neonates with moderate or severe HIE were prospectively enrolled, including 51 who received therapeutic hypothermia and 18 who did not. The mean duration of video-EEG monitoring was longer in the therapeutic hypothermia group (72 ± 34 hours vs 48 ± 34 hours; P =.01). The therapeutic hypothermia group had a lower electrographic seizure burden (log units) after controlling for injury, as assessed by MRI (2.9 ± 0.6 vs 6.2 ± 0.9; P =.003). A reduction in seizure burden was seen in neonates with moderate HIE (P =.0001), but not in those with severe HIE (P =.80). Among neonates with injury assessed by MRI, seizure burden was lower in those with mild (P =.0004) and moderate (P =.02) injury, but not in those with severe injury (P =.90). Conclusion: Therapeutic hypothermia was associated with reduced electrographic seizure burden in neonatal HIE. This effect was detected on video-EEG in infants with moderate HIE, but not in those with severe HIE. When stratified by injury as assessed by MRI, therapeutic hypothermia was associated with a reduced seizure burden in infants with mild and moderate injury, but not in those with severe injury.

Original languageEnglish (US)
Pages (from-to)465-470
Number of pages6
JournalJournal of Pediatrics
Volume163
Issue number2
DOIs
StatePublished - Aug 2013

Fingerprint

Brain Hypoxia-Ischemia
Induced Hypothermia
Seizures
Magnetic Resonance Imaging
Wounds and Injuries
Newborn Infant
Electroencephalography
Analysis of Variance
Students

Keywords

  • aEEG
  • Amplitude-integrated electroencephalography
  • EEG
  • Electroencephalography
  • HIE
  • Hypoxic ischemic encephalopathy
  • Magnetic resonance imaging
  • MRI

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Therapeutic hypothermia in neonatal hypoxic ischemic encephalopathy : Electrographic seizures and magnetic resonance imaging evidence of injury. / Srinivasakumar, Preethi; Zempel, John; Wallendorf, Michael; Lawrence, Russell; Inder, Terrie; Mathur, Amit.

In: Journal of Pediatrics, Vol. 163, No. 2, 08.2013, p. 465-470.

Research output: Contribution to journalArticle

Srinivasakumar, Preethi ; Zempel, John ; Wallendorf, Michael ; Lawrence, Russell ; Inder, Terrie ; Mathur, Amit. / Therapeutic hypothermia in neonatal hypoxic ischemic encephalopathy : Electrographic seizures and magnetic resonance imaging evidence of injury. In: Journal of Pediatrics. 2013 ; Vol. 163, No. 2. pp. 465-470.
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abstract = "Objective: To evaluate the electrographic seizure burden in neonates with hypoxic ischemic encephalopathy (HIE) treated with or without therapeutic hypothermia and stratified results by severity of HIE and severity of injury as assessed by magnetic resonance imaging (MRI). Study design: Between 2007 and 2011, video-electroencephalography (EEG) monitoring was initiated in neonates with moderate to severe HIE. Seizure burden (in seconds) was calculated, and brain MRI scans were quantitatively scored. Data were analyzed by ANOVA, the Student t test, and the χ2 test. Results: Sixty-nine neonates with moderate or severe HIE were prospectively enrolled, including 51 who received therapeutic hypothermia and 18 who did not. The mean duration of video-EEG monitoring was longer in the therapeutic hypothermia group (72 ± 34 hours vs 48 ± 34 hours; P =.01). The therapeutic hypothermia group had a lower electrographic seizure burden (log units) after controlling for injury, as assessed by MRI (2.9 ± 0.6 vs 6.2 ± 0.9; P =.003). A reduction in seizure burden was seen in neonates with moderate HIE (P =.0001), but not in those with severe HIE (P =.80). Among neonates with injury assessed by MRI, seizure burden was lower in those with mild (P =.0004) and moderate (P =.02) injury, but not in those with severe injury (P =.90). Conclusion: Therapeutic hypothermia was associated with reduced electrographic seizure burden in neonatal HIE. This effect was detected on video-EEG in infants with moderate HIE, but not in those with severe HIE. When stratified by injury as assessed by MRI, therapeutic hypothermia was associated with a reduced seizure burden in infants with mild and moderate injury, but not in those with severe injury.",
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