Selective Head versus Whole Body Cooling Treatment of Hypoxic-Ischemic Encephalopathy: Comparison of Electroencephalogram and Magnetic Resonance Imaging Findings

Ajay Goenka; Elissa Yozawitz; William A. Gomes; Suhas M. Nafday

doi:10.1055/s-0039-1693466

American Journal of Perinatology, Table of Contents

Am J Perinatol 2020; 37(12): 1264-1270
DOI: 10.1055/s-0039-1693466

Original Article

Selective Head versus Whole Body Cooling Treatment of Hypoxic-Ischemic Encephalopathy: Comparison of Electroencephalogram and Magnetic Resonance Imaging Findings

Ajay Goenka

¹Department of Neurology and Epilepsy, Dayton Children's Hospital, Dayton, Ohio

,

Elissa Yozawitz

²Saul Korey Department of Neurology, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York

,

William A. Gomes

³Department of Neuroradiology, Radiology, Advanced Physician Services, Hawthorne, New York

,

Suhas M. Nafday

⁴Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore (Jack D. Weiler Hospital of Einstein Division) and Albert Einstein College of Medicine, Bronx, New York

› Author Affiliations

Abstract

Objective This study aimed to compare the utility of electroencephalogram (EEG) and brain magnetic resonance imaging (MRI) to detect brain dysfunction and injury across a cohort of newborn infants treated with selective head cooling (SHC) or whole body cooling (WBC).

Study Design Therapeutic hypothermia (TH) is a standard neuroprotection tool for hypoxic-ischemic encephalopathy (HIE) in neonates. Sixty-six newborns, SHC (n = 22) and WBC (n = 44), were studied utilizing standardized scoring systems for interpretation of EEG and MRI based on the severity of the findings.

Results SHC- and WBC-treated groups did not differ significantly amongst most of the baseline parameters. EEGs obtained postcooling were abnormal in 58 of 61 (95%) infants. The severity of the EEG background changes (depressed and undifferentiated background) was more prevalent in the SHC (8/21 [38%]) than in the WBC group (5/40 [13%]). Brain MRIs showed HIE changes in 26 of 62 (42%) newborns treated with TH. MRI abnormalities of basal ganglia, thalamic, and parenchymal lesions were more common in the SHC (5/19) versus the WBC group (3/43); p = 0.04.

Conclusion EEG abnormalities and MRI findings of HIE were more prevalent in the SHC than in the WBC group. WBC may offer better or at least similar neuroprotection to infants with HIE.

Keywords

electroencephalogram - magnetic resonance imaging - hypoxic-ischemic encephalopathy - whole body cooling - selective head cooling - therapeutic hypothermia

Full Text

References

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