352 - Multi-modal Monitoring of Infants with Hypoxic-Ischaemic Encephalopathy and Prediction of Short-term Outcome.

Poster Number: 352
Publication Number: 352.443

Aisling A. Garvey, INFANT Research Centre, Boston, MA, United States; Brian H. Walsh, University College Cork, Cork, Cork, Ireland; Michael Moore, Cork University Hospital, Cork, Cork, Ireland; Sean Mathieson, INFANT Research Centre, University College Cork, Rosscarbery, Cork, Ireland; John M. O'Toole, University College Cork, Cork, Cork, Ireland; Vicki Livingstone, University College Cork, Cork, Cork, Ireland; Andreea M. Pavel, University College Cork, Cork, Cork, Ireland; Daragh Finn, university College cork, Cork, Cork, Ireland; Geraldine B. Boylan, University College Cork, Cork, Cork, Ireland; Deirdre M. Murray, University College Cork, Cork, Cork, Ireland; Eugene Dempsey, University Colleeg Cork, Cork, Cork, Ireland

Background: Hypoxic-ischaemic encephalopathy (HIE) carries a significant risk of brain injury and adverse neurodevelopmental outcome. Early identification of at-risk infants is critical to optimise intervention.

Objective: We aimed to investigate the ability of currently available, bedside monitoring techniques to predict short-term outcome in infants with HIE.

Design/Methods: Prospective observational study conducted in a tertiary neonatal intensive care unit in Cork, Ireland. Infants with all grades of HIE had continuous electroencephalography (EEG), non-invasive cardiac output monitoring (NICOM) and near-infrared spectroscopy (NIRS) commenced within the first 6hours of admission to the NICU.  One-hour epochs of time-synchronised data were selected at 6 and 12hours of age to assess their ability to predict short-term outcome. Adverse outcome was defined as abnormal MRI and/or death in the first week.  Moderate-Severe MR injury was defined as a Barkovich score of ≥2 in the deep grey matter and or a score of ≥3 in the watershed area.

Results: Fifty-seven infants with HIE were included (27 mild, 24 moderate, 6 severe). Median gestational age was 39.9weeks (IQR 38.1–40.7) and median birth weight was 3.4kgs (IQR 3.0-3.7). Eighteen infants (32%) had an adverse outcome (6/28 mild HIE, 7/24 moderate HIE and 5/6 severe HIE). At 6hours, no individual marker significantly predicted outcome. At 12hours, quantitative features of EEG spectral power significantly predicted adverse outcome (AUC 0.68, 95%CI 0.53-0.84, sensitivity 67%, specificity 53%).(Table 1) Both qualitative grading of the EEG and quantitative features of EEG spectral power significantly predicted moderate-severe injury: AUC 0.84, 95%CI 0.70-0.98, sensitivity 80%, specificity 74% and AUC 0.82, 95%CI 0.64-1.00, sensitivity 80%, specificity 65% respectively. NIRS and NICOM measurements were not helpful in identifying infants with adverse outcome and combining modalities did not improve prediction.Conclusion(s): Qualitative and quantitative EEG features at 12 hours were the best predictors of short-term MR outcome or death in infants with all grades of HIE. Quantitative EEG algorithms may be useful in the future to aid in the early prediction of infants at risk of brain injury.

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