EEG and MRI may specifically predict death among infants with hypoxic-ischemic encephalopathy: JAMA
Researchers have discovered that clinical models based on clinical, electroencephalography (EEG), and magnetic resonance imaging (MRI) data can accurately predict neonatal death or severe neurodevelopmental impairment (NDI) who are treated with therapeutic hypothermia for moderate to severe hypoxic-ischemic encephalopathy (HIE). A recent study was published in the journal JAMA Network Open conducted by Hannah c. and colleagues.
This was a prospective study of data from neonates born between January 2017 and October 2019 and enrolled in a large US clinical trial. Inclusion criteria were neonates born at or beyond 36 weeks gestation with moderate or severe HIE who had received therapeutic hypothermia and had two-year follow-up data. Clinical, EEG, and MRI data were collected at 24 hours and after cooling. The main outcome measured was the death or severe NDI at two years, operationalized by particular developmental and motor impairments. Model metrics of performance were validated internally as well as externally with a cohort from the UK.
General and Cohort Description :
Out of 424 newborns, the mean age of gestation was at 39.1 weeks (SD 1.4), and 45.3% were girls. The racial distribution featured 73.3% White, 11.8% Black, and 6.6% Asian newborns.
Severe encephalopathy was present in 105 neonates (24.7%) at enrollment.
Outcome Statistics:
Of the total cohort, 59 neonates (13.9%) died, and 46 (10.8%) had severe NDI by two years of age.
24-Hour Model:
The presence of three clinical factors—severely abnormal EEG, a pH level ≤ 7.11, and a 5-minute Apgar score of 0—had a specificity of 99.6% (95% CI: 97.5%-100%) and a PPV of 95.2% (95% CI: 73.2%-99.3%).
Internal validation was seen with specificity of 97.9% (95% CI: 92.7%-99.8%) and PPV of 77.8% (95% CI: 43.4%-94.1%).
External validation showed a specificity of 97.6% (95% CI: 95.1%-99.0%) with PPV of 46.2% (95% CI: 23.3%-70.8%).
Postcooling Model:
Combining MRI abnormalities in at least two of three deep gray matter regions (thalamus, caudate, putamen, and/or globus pallidus) with severely abnormal EEG at 24 hours had a specificity of 99.1% (95% CI: 96.8%-99.9%) and a PPV of 91.7% (95% CI: 72.8%-97.8%).
Internal validation obtained a specificity of 98.9% (95% CI: 94.1%-100%) with a PPV of 92.9% (95% CI: 64.2%-99.0%).
External validation reported a specificity of 98.6% (95% CI: 96.5%-99.6%) and a PPV of 83.3% (95% CI: 64.1%-93.4%).
In neonates with moderate or severe HIE treated with therapeutic hypothermia, simple models that included clinical, EEG, and MRI findings showed high specificity and positive predictive value for predicting death or severe NDI at two years. These models provide a practical and reliable approach to support early prognostication and clinical decision-making.
Reference:
Glass HC, Wood TR, Comstock BA, et al. Predictors of Death or Severe Impairment in Neonates With Hypoxic-Ischemic Encephalopathy. JAMA Netw Open. 2024;7(12):e2449188. doi:10.1001/jamanetworkopen.2024.49188
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