Abstracts

Rationale: Therapeutic hypothermia (TH) is becoming standard of care for newborns with hypoxic-ischemic encephalopathy (HIE). While neonatal seizure is considered an important risk factor for brain injury in this population, recent studies suggest that the outcome after seizures is not uniformly poor. Aim: describe two years of neurodevelopmental outcome in patients treated with hypothermiaMethods: Consecutive newborns who underwent whole body cooling at Bambino Gesú Children’s Hospital, Rome, Italy between March 2009 and November 2014 were studied with continuous video-EEG monitoring during TH and rewarming to detect seizures. Criteria for TH were based on those used in randomized controlled trial. Electrographic seizures were treated with antiepileptic drugs according to institutional guidelines. MRI was performed shortly after rewarming and after 6 months. Injury was scored as “none-mild” or “severe” (Barkovich et al., AJNR, 1998). Neurodevelopmental outcome was detected at 6 months, 1 year and 2 year of age using neurological evaluation, Video EEG recordings, and Griffiths Mental Development Scale (GMDS).Results: 50 patients (25 males) completed a full 72 hours TH. Two patients died before completed TH, one patient interrupted TH because multi-organ failure and subsequently died. Electrographic seizures were identified in 20/47 (42,5%) patients: 9 presented with isolated or recurrent seizures and 11 had SE. Twelve patients (60%) never showed a clinical correlate during seizures, including 5 with subclinical SE. Thirty eight infants (80%) had none or mild MRI injury while severe MRI injury was observed in 9 children (20%) shortly after birth; two patients died shortly after MRI. Forty five patients were eligible to follow-up (see Table).Conclusions: At any age of follow up patients with normal/mild neurological examination correspond to normal/mild neurodevelopmental outcome. Most of these patients presents with normal/mild brain MRI. Normal/mild brain MRI correlate to no/isolate seizures during TH. Few patients who present with normal/mild neurological examination and neurodevelopmental outcome despite severe brain MRI presented at birth with SE which required only one antie-epileptic drug (AED). On the other hand patients who present with severe neurological examination and neurodevelopmental outcome correspond to severe brain MRI and correlate to SE during TH which required two or more AEDs to be treated. Refractory SE or long lasting seizure which required more than 2 AEDs determinate worst outcome. No patients developped epilepsy.