Prediction of Neurodevelopmental Outcome in Hypoxic Ischemic Encephalopathy at 12 Months: Correlation of Brain MRI and EEG

Hee Cheol Jo; Eun Jeong Kim; Jang Hoon Lee; Da Eun Jung; Moon Sung Park; Sung Hwan Kim

doi:10.14734/kjp.2015.26.3.208

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Jo, Kim, Lee, Jung, Park, and Kim: Prediction of Neurodevelopmental Outcome in Hypoxic Ischemic Encephalopathy at 12 Months: Correlation of Brain MRI and EEG

Original Article

Korean J Perinatol 2015;26(3):208-214.

Published online: 20 September 2015

DOI: https://doi.org/10.14734/kjp.2015.26.3.208

Prediction of Neurodevelopmental Outcome in Hypoxic Ischemic Encephalopathy at 12 Months: Correlation of Brain MRI and EEG

Hee Cheol Jo, M.D., Eun Jeong Kim, M.D., Jang Hoon Lee, M.D., Da Eun Jung, M.D., Moon Sung Park, M.D., Ph.D., Sung Hwan Kim, M.D., Ph.D.

Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea

Correspondence to: Jang Hoon Lee, M.D. Department of Pediatrics, Ajou University School of Medicine San 5, Wonchon-dong, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5168, Fax: +82-31-219-5169 E-mail: neopedlee@gmail.com

Received 13 July 2015 Revised 6 September 2015 Accepted 12 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aims of this study were to estimate the neurodevelopmental outcome of hypoxic-ischemic encephalopathy (HIE) at 12 months, and determine the usefulness of brain magnetic resonance imaging (MRI) and electroencephalography (EEG) to predict neurodevelopmental outcome in term infants with HIE at 12 months.

Methods

This study was conducted retrospectively on term infants with HIE from January 2009 to June 2013. Based on neurodevelopmental outcome at 12 months, infants were categorized into 2 groups. Brain MRI and EEG findings were stratified into 4 categories as normal, mild, moderate and severe groups.

Results

Total 42 term infants were enrolled. Fifty seven point one percent (24/42) of total infants had favorable neurodevelopmental outcome at 12 months (favorable outcome, n=24). Thirty eight point one percent (16/42) of total infants had significant neurodevelopmental deficit at 12 months of age, and 4.8% (2/42) had mortality within 12 months (poor outcome, n=18). In brain MRI and EEG findings, there were significant correlations with neurodevelopmental outcome. Brain MRI showed sensitivity of 88.9%, specificity of 70.8%, positive predictive value of 69.6% and negative predictive value of 89.5%, while EEG showed sensitivity of 70.6%, specificity of 82.6%, positive predictive value of 75%, and negative predictive value of 79.2%. In the multivariate analysis, moderate-to-severe findings in brain MRI were the strongest risk factor (odds-ratio, 11.24; 95% confidence interval, 1.36–92.89; P=0.025).

Conclusion

Forty two point nine percent of total infants had poor neurodevelopmental outcome at 12 months. Brain MRI and EEG findings were correlated with neurodevelopmental outcome of term infants with HIE at 12 months.

Keywords: Asphyxia, Hypoxic ischemic encephalopathy, Developmental delay, Magnetic resonance imaging, Electroencephalography

References

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Table 1.

Categorization of Neurodevelopmental Outcomes in Term Infants with Hypoxic-Ischemic Encephalopathy at 12 Months

Normal
– Scores within 20% of age-normative values in DDST-II
– BSID-II, MDI score more than 85
Borderline
– Scores between 20% and 30% of age-normative values in DDST-II
– BSID-II, MDI score between 70 and 85
Severe
– Scores higher than 30% of age-normative values in DDST-II
– BSID-II, MDI score less than 69
– Death during the follow up period
Abbreviations: DDST-II, Denver Developmental Screening Test II; BSID-II, Bayley Scales of Infant Development II; MDI, mental development index

Table 2.

Comparison of Neurodevelopmental Outcomes according to Perinatal Characteristics

Characteristics	Favorable (n=24, 57.1%)	Poor (n=18, 42.9%)	P-value^†
Gestational age (weeks)^∗	39⁺²±2⁺²	39⁺³±1⁺²	0.461
Birth weight (g)^∗	3192±483	3129±467	0.675
Male infants, n (%)	15 (62.5%)	9 (50%)	0.533
Cesarean section, n (%)	16 (66.7%)	12 (66.7%)	1.000
Apgar score at 1 minute^∗	6.1±2.2	4.5±2.4	0.029
Apgar score at 5 minutes^∗	7.8±1.5	6.2±2.2	0.010
Initial pH <7.0, n (%)	4 (16.7%)	4 (22.2%)	0.706
Initial base deficit ≥12 mmol/L, n (%)	5 (20.8%)	9 (50.0%)	0.096
Meconium stained, n (%)	2 (8.3%)	3 (7.1%)	0.636
Fetal distress, n (%)	8 (33.3%)	5 (27.8%)	0.748
Abnormal presentation, n (%)	5 (11.9%)	1 (2.4%)	0.214
Neonatal seizure, n (%)	21 (87.5%)	16 (43.2%)	1.000

^∗ Data are given as mean±standard deviation.

^† Student-t test and chi-square test.

Table 3.

Correlation of Brain Magnetic Resonance Imaging with Neurodevelopmental Outcome of Infants with HypoxicIschemic Encephalopathy

	Favorable (n=24)	Poor (n=18)	P-value^∗
Normal-to-mild findings of MRI, n (%)	17 (70.8%)	2 (11.1%)	<0.001
Moderate-to-severe findings of MRI, n (%)	7 (29.2%)	16 (88.9%)

Abbreviation: MRI, magnetic resonance imaging.

^∗ Fisher's exact test.

Table 4.

Correlation of Electroencephalography with Neurodevelopmental Outcome of Infants with Hypoxic-Ischemic Encephalopathy

	Favorable (n=23)	Poor (n=17)	P-value^∗
Normal-to-mild findings of EEG, n (%)	19 (82.6%)	5 (29.4%)	0.001
Moderate-to-severe findings of EEG, n (%)	4 (17.4%)	12 (70.6%)

Abbreviation: EEG, electroencephalography.

^∗ Fisher's exact test.

Table 5.

Significance of Risk Factors Related Prediction of Neurodevelopmental Outcomes in Hypoxic-Ischemic Encephalopathy by Multivariate Logistic Regression Analysis

	Adjusted odds ratio	P-value	95% confidence interval
1-min Apgar score	1.63	0.282	0.67–3.99
5-min Apgar score	0.44	0.171	0.14–1.43
Base deficit	0.98	0.831	0.85–1.14
Brain MRI findings	11.24	0.025	1.36–92.89
EEG findings	3.31	0.254	0.42–25.92

Abbreviations: MRI, magnetic resonance imaging; EEG, electroencephalography.

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