Prognostic value of electroencephalography in hypoxic-ischemic encephalopathy

  • Laura López-Viñas Fundación Jiménez Díaz University Hospital
  • Patricia Navas-Sánchez
  • Victoria Fernández-Sánchez
  • Lucía Rodríguez-Santos
  • Enrique Bauzano-Poley
  • María del Pilar Abollo-López
  • Julia Harvey
  • Miguel Ángel Barbancho-Fernández
Keywords: Clinical neurophysiology; Electroencephalography; Encephalopathy; Neonatology; Neurodevelopment.


Background: Hypoxic-ischemic encephalopathy (HIE) is one of the main causes of neurodevelopmental disorders. We developed a model that has diagnostic and prognostic value in predicting the neurodevelopmental outcomes in newborns with HIE. HIE staging allows us to start therapeutic interventions early in newborns with suspected encephalopathy. Methods: This was a retrospective study in a cohort of 58 full-term neonates with clinical suspicion of HIE. We assessed electroclinical variables at birth [etiology of hypoxia, neonatal seizures, HIE stages based on Sarnat criteria, use of therapeutic hypothermia, neuroimaging tests and electroencephalography (EEG) findings] and two years of follow up (EEG findings, development of epilepsy, the presence of cognitive deficits, behavioral issues, language problems, visual or hearing disturbances, and cerebral palsy). Results: There was a high electro-clinical correlation to severe HIE (88.8%) and moderate HIE (50%). There was a considerable proportion of patients affected by mild HIE, based on clinical examination, who presented with an abnormal EEG (32.3%). There is a relationship between the onset of neonatal seizures, epilepsy, and severe HIE diagnosed with EEG (88.9%). A higher percentage of patients with moderate and severe HIE, based on EEG findings, present abnormal results in cranial ultrasound and cerebral magnetic resonance imaging (62.5%). At two years of age, functional neurodevelopment disturbances were observed most frequently in patients affected with severe and moderate HIE based on EEG. Conclusions: This study shows a model with diagnostic and prognostic value in predicting newborns' neurodevelopmental outcomes with suspected HIE. This knowledge allows us to assess the role of performing serial EEG in patients with suspected HIE and the relevance of EEG findings in the prognosis of neurodevelopmental disorders.


[1] A. Temko, O. Doyle, D. Murray, G. Lightbody, G. Boylan, and W. Marnane, “Multimodal predictor of neurodevelopmental outcome in newborns with hypoxic-ischaemic encephalopathy,” Comput. Biol. Med., vol. 63, pp. 169–177, Aug. 2015, doi: 10.1016/j.compbiomed.2015.05.017.
[2] N. E. Lynch, N. J. Stevenson, V. Livingstone, B. P. Murphy, J. M. Rennie, and G. B. Boylan, “The temporal evolution of electrographic seizure burden in neonatal hypoxic ischemic encephalopathy,” Epilepsia, vol. 53, no. 3, pp. 549–557, Mar. 2012, doi: 10.1111/j.1528-1167.2011.03401.x.
[3] M. A. Awal, M. M. Lai, G. Azemi, B. Boashash, and P. B. Colditz, “EEG background features that predict outcome in term neonates with hypoxic ischaemic encephalopathy: A structured review,” Clin. Neurophysiol. Off. J. Int. Fed. Clin. Neurophysiol., vol. 127, no. 1, pp. 285–296, Jan. 2016, doi: 10.1016/j.clinph.2015.05.018.
[4] C. J. Wusthoff et al., “Interrater agreement in the interpretation of neonatal electroencephalography in hypoxic-ischemic encephalopathy,” Epilepsia, vol. 58, no. 3, pp. 429–435, Mar. 2017, doi: 10.1111/epi.13661.
[5] M. C. Toet and P. M. A. Lemmers, “Brain monitoring in neonates,” Early Hum. Dev., vol. 85, no. 2, pp. 77–84, Feb. 2009, doi: 10.1016/j.earlhumdev.2008.11.007.
[6] V. Jadas et al., “[The contribution of the clinical examination, electroencephalogram, and brain MRI in assessing the prognosis in term newborns with neonatal encephalopathy. A cohort of 30 newborns before the introduction of treatment with hypothermia],” Arch. Pediatr. Organe Off. Soc. Francaise Pediatr., vol. 21, no. 2, pp. 125–133, Feb. 2014, doi: 10.1016/j.arcped.2013.11.007.
[7] H. van Laerhoven, T. R. de Haan, M. Offringa, B. Post, and J. H. van der Lee, “Prognostic tests in term neonates with hypoxic-ischemic encephalopathy: a systematic review,” Pediatrics, vol. 131, no. 1, pp. 88–98, Jan. 2013, doi: 10.1542/peds.2012-1297.
[8] B. H. Walsh, D. M. Murray, and G. B. Boylan, “The use of conventional EEG for the assessment of hypoxic ischaemic encephalopathy in the newborn: a review,” Clin. Neurophysiol. Off. J. Int. Fed. Clin. Neurophysiol., vol. 122, no. 7, pp. 1284–1294, Jul. 2011, doi: 10.1016/j.clinph.2011.03.032.
[9] P. D. Gluckman et al., “Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial,” Lancet Lond. Engl., vol. 365, no. 9460, pp. 663–670, Feb. 2005, doi: 10.1016/S0140-6736(05)17946-X.
[10] S. Shankaran et al., “Whole-Body Hypothermia for Neonates with Hypoxic–Ischemic Encephalopathy,” N. Engl. J. Med., vol. 353, no. 15, pp. 1574–1584, Oct. 2005, doi: 10.1056/NEJMcps050929.
[11] D. Azzopardi and TOBY study group, “Predictive value of the amplitude integrated EEG in infants with hypoxic ischaemic encephalopathy: data from a randomised trial of therapeutic hypothermia,” Arch. Dis. Child. Fetal Neonatal Ed., vol. 99, no. 1, pp. F80-82, Jan. 2014, doi: 10.1136/archdischild-2013-303710.
[12] S. E. Jacobs et al., “Whole-Body Hypothermia for Term and Near-Term Newborns With Hypoxic-Ischemic Encephalopathy: A Randomized Controlled Trial,” Obstet. Gynecol. Surv., vol. 66, no. 12, p. 743, Dec. 2011, doi: 10.1097/OGX.0b013e31824022f4.
[13] J. M. Novoa P et al., “Consenso sobre manejo integral del neonato con encefalopatía hipóxico isquémica,” Rev. Chil. Pediatría, vol. 83, no. 5, pp. 492–501, Oct. 2012, doi: 10.4067/S0370-41062012000500012.
[14] M. Martínez-Biarge, D. Blanco, A. García-Alix, and S. Salas, “Seguimiento de los recién nacidos con encefalopatía hipóxico-isquémica,” An. Pediatría, vol. 81, no. 1, p. 52.e1-52.e14, Jul. 2014, doi: 10.1016/j.anpedi.2013.06.015.
[15] A. García-Alix, M. M. Biarge, J. Arnaez, E. Valverde, and J. Quero, “Asfixia intraparto y encefalopatía hipóxico-isquémica.” .
[16] M.-D. Lamblin, E. Walls Esquivel, and M. André, “The electroencephalogram of the full-term newborn: review of normal features and hypoxic-ischemic encephalopathy patterns,” Neurophysiol. Clin. Clin. Neurophysiol., vol. 43, no. 5–6, pp. 267–287, Dec. 2013, doi: 10.1016/j.neucli.2013.07.001.
[17] M. Polat et al., “Prediction of neurodevelopmental outcome in term neonates with hypoxic-ischemic encephalopathy,” Eur. J. Paediatr. Neurol. EJPN Off. J. Eur. Paediatr. Neurol. Soc., vol. 17, no. 3, pp. 288–293, May 2013, doi: 10.1016/j.ejpn.2012.11.004.
[18] R. M. Pressler, G. B. Boylan, M. Morton, C. D. Binnie, and J. M. Rennie, “Early serial EEG in hypoxic ischaemic encephalopathy,” Clin. Neurophysiol. Off. J. Int. Fed. Clin. Neurophysiol., vol. 112, no. 1, pp. 31–37, Jan. 2001.
[19] L. Kharoshankaya et al., “Seizure burden and neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy,” Dev. Med. Child Neurol., vol. 58, no. 12, pp. 1242–1248, Dec. 2016, doi: 10.1111/dmcn.13215.
[20] P. Srinivasakumar, J. Zempel, M. Wallendorf, R. Lawrence, T. Inder, and A. Mathur, “Therapeutic hypothermia in neonatal hypoxic ischemic encephalopathy: electrographic seizures and magnetic resonance imaging evidence of injury,” J. Pediatr., vol. 163, no. 2, pp. 465–470, Aug. 2013, doi: 10.1016/j.jpeds.2013.01.041.
[21] M. El-Ayouty, H. Abdel-Hady, S. El-Mogy, H. Zaghlol, M. El-Beltagy, and H. Aly, “Relationship between electroencephalography and magnetic resonance imaging findings after hypoxic-ischemic encephalopathy at term,” Am. J. Perinatol., vol. 24, no. 8, pp. 467–473, Sep. 2007.
[22] T. Nanavati, N. Seemaladinne, M. Regier, P. Yossuck, and P. Pergami, “Can We Predict Functional Outcome in Neonates with Hypoxic Ischemic Encephalopathy by the Combination of Neuroimaging and Electroencephalography?,” Pediatr. Neonatol., vol. 56, no. 5, pp. 307–316, Oct. 2015, doi: 10.1016/j.pedneo.2014.12.005.
[23] A. Foran, C. Cinnante, A. Groves, D. V. Azzopardi, M. A. Rutherford, and F. M. Cowan, “Patterns of brain injury and outcome in term neonates presenting with postnatal collapse,” Arch. Dis. Child. Fetal Neonatal Ed., vol. 94, no. 3, pp. F168-177, May 2009, doi: 10.1136/adc.2008.140301.
How to Cite
Laura López-Viñas, Patricia Navas-Sánchez, Victoria Fernández-Sánchez, Lucía Rodríguez-Santos, Enrique Bauzano-Poley, María del Pilar Abollo-López, Julia Harvey, & Miguel Ángel Barbancho-Fernández. (2021). Prognostic value of electroencephalography in hypoxic-ischemic encephalopathy. International Journal of Integrative Pediatrics and Environmental Medicine, 6, 9 - 19.