Cerebral oxygenation and brain activity after perinatal asphyxia: does hypothermia change their prognostic value?

BACKGROUND: Hypothermia is an established therapy in term neonates to reduce death and disability after perinatal asphyxia. Near-infrared spectroscopy-monitored regional cerebral oxygen saturation (rScO(2)) and amplitude-integrated electroencephalogram (aEEG)-monitored background pattern have been shown to be early predictors of long-term neurodevelopmental outcome. The aim of this study was to investigate the prognostic value of rScO(2) and a EEG for neurodevelopmental outcome in neonates with hypoxic ischemic encephalopathy (HIE) treated with hypothermia. METHODS: In neonates with HIE who were subjected to hypothermia, the aEEG background pattern and rScO(2) were studied prospectively from admission up to 84 h in relation to early magnetic resonance imaging and neurodevelopmental outcome at 18 mo of age. RESULTS: Of 39 infants, 12 neonates died because of neurological deterioration. One had an adverse outcome and 26 had a favorable outcome. The rScO(2) was higher in neonates with adverse outcome, although aEEG scores were lower. Positive predictive values at 12, 24, and 36 h of age for adverse outcome ranged from 50 to 67% for rScO(2) and a EEG; negative predictive values ranged from 73 to 96% for rScO(2) and 90 to 100% for aEEG. Combining rScO(2) and aEEG increased positive predictive values (70-91%) and negative predictive values (90-100%). CONCLUSION: During hypothermia, rScO(2) and aEEG measurements are early predictors of long-term outcome after HIE. Combining both parameters further improves early prediction.