Prognostic Indicators of Reorientation of Care in Perinatal Hypoxic-Ischemic Encephalopathy Spectrum

Krishna Raghu; Brian T Kalish; Emily W Y Tam; Amr El Shahed; Vann Chau; Diane Wilson; Sandra Tung; Vanna Kazazian; Atiyeh A Miran; Cecil Hahn; Helen M Branson; Linh G Ly; Mehmet N Cizmeci

doi:10.1016/j.jpeds.2024.114273

Prognostic Indicators of Reorientation of Care in Perinatal Hypoxic-Ischemic Encephalopathy Spectrum

J Pediatr. 2025 Jan:276:114273. doi: 10.1016/j.jpeds.2024.114273. Epub 2024 Aug 30.

Authors

Affiliations

¹ Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
² Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
³ Division of Radiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
⁴ Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. Electronic address: mehmet.cizmeci@sickkids.ca.

PMID: 39216619
DOI: 10.1016/j.jpeds.2024.114273

Abstract

Objective: To investigate the clinical, electrographic, and neuroimaging characteristics in neonates with perinatal hypoxic-ischemic encephalopathy who underwent reorientation of care using standardized scoring systems.

Study design: A nested observational substudy within a prospective hypoxic-ischemic encephalopathy cohort was conducted. Group 1 comprised infants whose parents received the medical recommendation for reorientation of care, while group 2 continued to receive standard care. Encephalopathy scores were monitored daily. Amplitude-integrated and continuous-video-integrated electroencephalogram during therapeutic hypothermia were analyzed. Standardized scoring systems for cranial ultrasonography and postrewarming brain magnetic resonance imaging were deployed.

Results: The study included 165 infants, with 35 in group 1 and 130 in Group 2. By day 3, all infants in group 1 were encephalopathic with higher Thompson scores (median 13 [IQR 10-19] vs 0 [IQR 0-3], P < .001). Electrographic background normalization within 48 hours occurred in 3% of group 1 compared with 46% of group 2 (P < .001). Sleep-wake cycling was not observed in group 1 and emerged in 63% of group 2 within the first 72 hours (P < .001). The number of antiseizure medications received was higher in group 1 (median 3 [IQR, 2-4] vs 0 [IQR, 0-1], respectively; P < .001). Group 1 had higher cranial ultrasound injury scores (median 4 [IQR 2-7] vs 1 [IQR 0-1], P < .001) within 48 hours and postrewarming brain magnetic resonance imaging injury scores (median 33 [range 20-51] vs 4 [range 0-28], P < .001).

Conclusions: Neonates with perinatal hypoxic-ischemic encephalopathy who underwent reorientation of care presented with and maintained significantly more pronounced clinical manifestations, electrographic findings, and near-total brain injury as scored objectively on all modalities.

Trial registration: Registration of the study cohort: NCT04913324.

Keywords: electroencephalography; hypoxic-ischemic encephalopathy; magnetic resonance imaging; newborn.

Publication types

Observational Study

MeSH terms

Electroencephalography*
Female
Humans
Hypothermia, Induced* / methods
Hypoxia-Ischemia, Brain* / diagnosis
Hypoxia-Ischemia, Brain* / diagnostic imaging
Hypoxia-Ischemia, Brain* / therapy
Infant, Newborn
Magnetic Resonance Imaging*
Male
Prognosis
Prospective Studies

Associated data

ClinicalTrials.gov/NCT04913324