Epilepsy Risk Factors IDed for Neonates with Hypoxic Ischemic Encephalopathy

BALTIMORE — Neonates with hypoxic ischemic encephalopathy who undergo therapeutic head cooling may have a higher risk of epilepsy if they have certain risk factors, according to a study presented at the American Neurological Association 2014 Annual Meeting.

Tiffani McDonough, MD, of the Neurological Institute of New York, and colleagues found that 16% of neonates who underwent therapeutic head cooling (THC) for hypoxic ischemic encephalopathy (HIE) would develop epilepsy within 2 years.

They reviewed clinical data for 49 neonates with HIE on THC protocol and had a 2-year follow up. In the neonatal period, 95% experienced seizures that were identified clinically. After the follow up, 16% had developed epilepsy.

Significant risk factors were determined using multivariable analysis and included:

• pH≤6.8 on the first day of day of life (P=50.05)
• Prolonged continuous digital video and electroencephalographic monitoring (cEEG) at 72 hours and 96 hours with burst suppression pattern (P=0.03)
• MRI with evidence of basal ganglia injury (P=50.009)

Those with zero to one risk factors were in a low-risk group, whereas those with two to three risk factors were in a high-risk group.

Neonates undergoing THC for HIE have the greatest risk of epilepsy with initial acidemia, burst suppression pattern on cEEG at 72 to 96 hours of life, and basal ganglia injury on MRI, the findings indicated. Surveillance of neonates should increase as their number of risk factors increase, the researchers recommended.

References

1. McDonough T. Abstract #S907 “Prediction of Future Epilepsy in Neonates with HIE.” Presented at: American Neurological Association 2014 Annual Meeting. October 12-14, 2014; Baltimore.