Relationship between EEG spectral power and dysglycemia with outcomes after neonatal encephalopathy
Poster No:
391
Submission Type:
Abstract Submission
Authors:
Janie Damien1, Phetsamone Vannasing2, Julie Tremblay2, Laurence Petitpas2, Bohdana Marandyuk2, Thameya Balasingam2, Ramy El Jalbout2, Natacha Paquette2, Gianluca Donofrio2, Anne Gallagher3, Elana Pinchefsky2
Institutions:
1University of Montreal, Montreal, Québec, 2Sainte-Justine University Hospital Centre, Montreal, Quebec, 3Sainte-Justine University Hospital Centre, Monytreal, Quebec
First Author:
Co-Author(s):
Introduction:
Identification of early markers of brain function is essential to aid in the prediction of neurodevelopmental outcomes following neonatal encephalopathy (NE) even with implementation of effective neuroprotective interventions like therapeutic hypothermia. Potentially modifiable risk factors such as dysglycemia are frequent in the first hours of life in neonates with encephalopathy and may contribute to impaired brain function and long-term adverse outcomes. The relationship between dysglycemia and brain function after therapeutic hypothermia and at follow-up in NE needs to be further investigated to improve prediction of outcomes. Therefore, we studied how dysglycemia and brain function on electroencephalography (EEG) following therapeutic hypothermia relate to neurodevelopmental outcomes in children with NE. We hypothesized that neonatal dysglycemia (hypo- or hyperglycemia in the first 0-48 hours of life) and EEG spectral power (measured during the post-rewarming period and the 2-month follow-up) in NE are related to neurodevelopmental outcomes at ≥18 months.
Methods:
This retrospective study included 90 neonates with encephalopathy who received therapeutic hypothermia and underwent EEG monitoring according to the international 10–20 system, including electrodes Fp1\Fp2, C3\C4, T3\T4, and O1\O2. Absolute spectral power was calculated from artifact-free EEG signals during the 6-hour post-rewarming period and the 30-minute routine follow-up at 2-months, within all frequency bands (delta, theta, alpha, beta, total) and brain regions (frontal, central, temporal, occipital, and global average of all electrodes). Measures of dysglycemia (hypoglycemia, hyperglycemia, and glycemic lability) and glucose variability (mean absolute glucose change) were computed for the first 48 hours of life. Brain magnetic resonance imaging (MRI) was also performed in neonates after the completion of therapeutic hypothermia (at 5 ± 2 days of life). Neurodevelopmental outcomes included motor, language, or global developmental delays, visual impairments, auditory deficits, cerebral palsy, mortality, and a composite measure of normal/mild or moderate/severe outcome at ≥18 months. Using logistic regression analyses with area under receiver operating characteristic (AUROC) curves, we evaluated EEG and glucose variables in separate and combined models to predict neurodevelopmental outcomes, adjusting for NE severity and MRI brain injury, and using Bonferroni correction for multiple comparisons.
Results:
Global delta power during post-rewarming and dysglycemia (hyperglycemia and glycemic lability) during the first 0-48 hours of life were the variables with the highest predictive values for moderate/severe neurodevelopmental outcome (AUROC=0.8, 95%CI 0.7;0.9 for both models). The combined model including global delta power post-rewarming and neonatal dysglycemia more accurately predicted moderate/severe neurodevelopmental outcome (AUROC=0.9, 95%CI [0.8,0.9], p<.001). After adjusting for NE severity and MRI brain injury, only higher global delta power post-rewarming remained significantly associated with lower odds of moderate/severe neurodevelopmental outcome (OR=0.9, 95%CI [0.8,1.0], p=.04), gross motor delay (OR=0.9, 95%CI [0.8,1.0], p=.04), global developmental delay (OR=0.9, 95%CI [0.8,1.0], p=.04), and auditory deficits (OR=0.9, 95%CI [0.8,1.0], p=.03).
·ROC curves for univariable and multivariable prediction models.
Conclusions:
This study identified quantitative EEG markers of brain function after therapeutic hypothermia that are associated with higher risks of unfavorable neurodevelopmental outcomes. Among neonates with encephalopathy, global delta power during post-rewarming and dysglycemia during the first 48 hours of life accurately predicted moderate/severe neurodevelopmental outcomes at ≥18 months, when measures were used separately, and even more so when combined. Global delta power post-rewarming predicted neurodevelopmental outcomes, even after adjusting for NE severity and MRI brain injury.
Disorders of the Nervous System:
Neurodevelopmental/ Early Life (eg. ADHD, autism) 1
Modeling and Analysis Methods:
Classification and Predictive Modeling
EEG/MEG Modeling and Analysis 2
Multivariate Approaches
Task-Independent and Resting-State Analysis
Keywords:
Development
DISORDERS
Electroencephaolography (EEG)
MRI
Multivariate
Neurological
PEDIATRIC
Pediatric Disorders
Univariate
1|2Indicates the priority used for review