Abstracts

Rationale: Therapeutic hypothermia (TH) has become established as a standard of care for newborns with moderate-severe hypoxic-ischemic encephalopathy (HIE). TH remains the only neuroprotective therapy to date. EEG has been identified as useful in prognosis during TH, with features of the background at 36-48 hours (most protocols include 3 days of EEG monitoring) highly predictive of both MRI and neurodevelopmental outcome. The classification of neonatal EEG used in studies is not standardized, and the outcome of infants with a discontinuous EEG pattern remains understudied. We performed a retrospective analysis in a cohort of 49 infants using a published EEG classification scheme and focused on the infants with a discontinuous background pattern to determine if further stratification, taking into account the degree of discontinuity and state definition as well as the trends over time, would be of benefit in predicting outcome. Methods: 49 term infants with a diagnosis of HIE who had TH were studied. Scores were assigned to the EEG on days 1, 2, and 3 using a classification scheme with the addition of categories within the discontinuous background group to capture level of severity. The results of the EEG, designation of the presence or absence of seizures (electrographic only or electrographic and clinical, status epilepticus), MRI, and neurodevelopmental outcome were tabulated to look for correlation between these data. Results: see tables Conclusions: 1. Continuous EEG can be helpful to identify trends and evolution of the background which may in turn be helpful in prognosis during TH2. Sub-classification of the discontinuous background group reflecting severity and trends correlates with outcome and improves accuracy of prognosis for this group.3. Further studies are needed to increase understanding of TH usefulness and may lead to more selective application of this therapy, change in neonatologists management, and revision of protocols being used to identify candidates for TH.