Abstract
Objective: To detect EEG background, the prevalence of seizures during cooling, and to determine different EEG patterns that can predict brain injury in magnetic resonance imaging MRI.
Materials and Methods: 39 newborns with HIE were subjected to TH(therapeutic hypothermia). Continuous monitoring by video-EEG was carried out throughout cooling and during rewarming. MRI was done for all newborns after rewarming. The predictive value of EEG background for MRI brain injury was evaluated at 6-hour intervals during cooling and rewarming. Results: At all time intervals, normal EEG was associated with no or mild MRI brain injury. At the beginning of cooling normal background was more predictive of a favorable MRI outcome than at later time points. After 24 hours of monitoring, diffuse burst suppression and depressed patterns had the greatest prognostic value. In most patients, a discontinuous pattern was not associated with poor prognosis.
31% developed electrical seizures, and 8% developed status epilepticus. Seizures were subclinical in 42%.There is a significant association between duration of seizure patterns detected on EEG and severity of brain injury on MRI. In conclusion: Continuous EEG monitoring in newborns with HIE under cooling has a prognostic value about early MRI brain injury and identifies electrographic seizures, approximately 50% of which are subclinical.Treatment of clinical and subclinical seizures results in a reduction of the total duration of seizure pattern supports the hypothesis that subclinical seizures should be treated.
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