Early clinical predictors of a severely abnormal amplitude-integrated electroencephalogram at 48hours in cooled neonates

Aim There is a need to identify infants with hypoxic ischaemic encephalopathy who have a poor outcome despite therapeutic hypothermia. A severely abnormal amplitude-integrated electroencephalogram at 48h predicts death or disability. Our aim was to determine whether clinical assessment at age 3-5h predicts a severely abnormal amplitude-integrated electroencephalogram at 48h or death in cooled infants. Methods Forty-one cooled infants, 36weeks' gestation, with moderate-to-severe hypoxic ischaemic encephalopathy, were prospectively enrolled. Infants who were moribund, had congenital conditions associated with encephalopathy or had severe cardio-respiratory instability were excluded. The predictive abilities of the Thompson encephalopathy score and individual signs at age 3-5h were assessed. Results All infants with a Thompson score 16 at 3-5h had a severely abnormal amplitude-integrated electroencephalogram at 6h and an abnormal short-term outcome. At 48h, 75% had a severely abnormal aEEG or died vs. 18% with a score <16 (p=0.004). Multivariate analysis did not find a significant independent association with any of the individual signs. Conclusion The Thompson score could be useful to identify infants who will have a poor outcome despite cooling. A score 16 should be validated as a prespecified variable in prospective studies.