The Impact of Phenobarbital and Bumetanide on Electroencephalogram Background Scoring in Infants with Perinatal Asphyxia During Therapeutic Hypothermia
Abstract number :
2.024
Submission category :
3. Neurophysiology / 3C. Other Clinical EEG
Year :
2021
Submission ID :
1825631
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:44 AM
Authors :
Asri Yuliati, MD - University of South Alabama; Michael Zayek, MD - Professor of Pediatrics, Department of Pediatrics, Division of Neonatology, University of South Alabama; Paul Maertens, MD - Professor of Neurology, Department of Neurology, Child Neurology Division, University of South Alabama
Rationale: Electroencephalogram (EEG) background severity grading performed soon after birth has been found to be a predictor of disability rates in infants with perinatal asphyxia with and without therapeutic hypothermia (TH) 1-3. However, the impact of antiepileptics on EEG background scoring in this patient population has not been studied.
The aim of this study is to determine if initial EEG background scoring after treatment with phenobarbital (PB) and bumetanide during TH remains a good predictor for brain injury in neonates with hypoxic ischemic encephalopathy (HIE).
Methods: This is a single-center, retrospective study of consecutive neonates treated for HIE from October 2017 through March 2021 and monitored with continuous EEG. The initial treatment of these infants consisted of one dose of prophylactic bumetanide 0.1mg/kg and one loading dose of phenobarbital 40mg/kg at the onset of therapeutic hypothermia for a duration of 72 hours per institutional protocol. EEG was initiated after induction of TH and anticonvulsant therapy. First 3 hours EEG background activity was classified as previously described2. MRI Brain was performed on all infants soon after rewarming, and results were scored based on NICHD criteria4. Infants were separated in two groups based on EEG background score, group 1 (normal-mild grades, score 0-1; n=30), group 2 (moderate-severe grades, score 2-4, n=36). The adverse outcome was defined as death before MRI or presence of brain injury on MRI (NICHD brain injury score ≥1a). The association between moderate-severe grades of EEG and presence of adverse outcome was assessed using logistic regression analysis.
Results: Charts of seventy infants were reviewed. Four infants were excluded, three due to lack of EEG data, and one due to the need for ECMO therapy in another facility. Initial EEG background score of 2-4 (group 2) was significantly associated with adverse outcome with odds ratio (OR) of 22 (95% CI 3.0-178.0) p=0.004. Median (interquartile range) time from admission to EEG hookup was 15 (11-18) hours in group 1 while it was 5 (3-18) hours in group 2, p=0.02. The association between severity of EEG background and adverse outcome remained significant even after adjustment for severe acidemia (postnatal arterial pH< 7.1), presence of seizures, low Apgar score (< 5 at 5 minutes), and time to EEG hookup [OR 49 (95% CI 4.0-657.0), p=0.003]. The area under the curve of the ROC curve of this model is 0.89. Two patients (3.0%) from group 2 died during neonatal period prior to MRI while all patients in group 1 survived.
Neurophysiology