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

Authors

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

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

References
1 Azzopardi D, Brocklehurst P, Edwards D. , et al; TOBY Study Group. The TOBY Study. Whole body hypothermia for the treatment of perinatal asphyxial encephalopathy: a randomised controlled trial. BMC Pediatr 2008; 8: 17
2 Gluckman PD, Wyatt JS, Azzopardi D. , et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomised trial. Lancet 2005; 365 (9460): 663-670
3 Jacobs SE, Morley CJ, Inder TE. , et al; Infant Cooling Evaluation Collaboration. Whole-body hypothermia for term and near-term newborns with hypoxic-ischemic encephalopathy: a randomized controlled trial. Arch Pediatr Adolesc Med 2011; 165 (08) 692-700
4 Zhou WH, Cheng GQ, Shao XM. , et al; China Study Group. Selective head cooling with mild systemic hypothermia after neonatal hypoxic-ischemic encephalopathy: a multicenter randomized controlled trial in China. J Pediatr 2010; 157 (03) 367-372
5 Higgins RD, Raju T, Edwards AD. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Hypothermia Workshop Speakers and Moderators. Hypothermia and other treatment options for neonatal encephalopathy: an executive summary of the Eunice Kennedy Shriver NICHD workshop. J Pediatr 2011; 159 (05) 851.e1-858.e1
6 Barks JD. Technical aspects of starting a neonatal cooling program. Clin Perinatol 2008; 35 (04) 765-775
7 Azzopardi DV, Strohm B, Edwards AD. , et al; TOBY Study Group. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med 2009; 361 (14) 1349-1358
8 Gunn AJ, Gluckman PD. Head cooling for neonatal encephalopathy: the state of the art. Clin Obstet Gynecol 2007; 50 (03) 636-651
9 Shankaran S, Laptook AR, Ehrenkranz RA. , et al; National Institute of Child Health and Human Development Neonatal Research Network. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353 (15) 1574-1584
10 Edwards AD, Brocklehurst P, Gunn AJ. , et al. Neurological outcomes at 18 months of age after moderate hypothermia for perinatal hypoxic ischaemic encephalopathy: synthesis and meta-analysis of trial data. BMJ 2010; 340: c363
11 Tagin MA, Woolcott CG, Vincer MJ, Whyte RK, Stinson DA. Hypothermia for neonatal hypoxic ischemic encephalopathy: an updated systematic review and meta-analysis. Arch Pediatr Adolesc Med 2012; 166 (06) 558-566
12 Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev 2013; (01) CD003311
13 Cady EB, Costello AM, Dawson MJ. , et al. Non-invasive investigation of cerebral metabolism in newborn infants by phosphorus nuclear magnetic resonance spectroscopy. Lancet 1983; 1 (8333): 1059-1062
14 Murray DM, Ryan CA, Boylan GB, Fitzgerald AP, Connolly S. Prediction of seizures in asphyxiated neonates: correlation with continuous video-electroencephalographic monitoring. Pediatrics 2006; 118 (01) 41-46
15 Nash KB, Bonifacio SL, Glass HC. , et al. Video-EEG monitoring in newborns with hypoxic-ischemic encephalopathy treated with hypothermia. Neurology 2011; 76 (06) 556-562
16 Holmes GL, Lombroso CT. Prognostic value of background patterns in the neonatal EEG. J Clin Neurophysiol 1993; 10 (03) 323-352
17 Lamblin MD, André M, Challamel MJ. , et al. Electroencephalography of the premature and term newborn. Maturational aspects and glossary [in French]. Neurophysiol Clin 1999; 29 (02) 123-219
18 Okereafor A, Allsop J, Counsell SJ. , et al. Patterns of brain injury in neonates exposed to perinatal sentinel events. Pediatrics 2008; 121 (05) 906-914
19 de Vries LS, Groenendaal F. Patterns of neonatal hypoxic-ischaemic brain injury. Neuroradiology 2010; 52 (06) 555-566
20 Laptook AR, Shalak L, Corbett RJ. Differences in brain temperature and cerebral blood flow during selective head versus whole-body cooling. Pediatrics 2001; 108 (05) 1103-1110
21 Sarkar S, Donn SM, Bapuraj JR, Bhagat I, Barks JD. Distribution and severity of hypoxic-ischaemic lesions on brain MRI following therapeutic cooling: selective head versus whole body cooling. Arch Dis Child Fetal Neonatal Ed 2012; 97 (05) F335-F339
22 Thoresen M, Simmonds M, Satas S, Tooley J, Silver IA. Effective selective head cooling during posthypoxic hypothermia in newborn piglets. Pediatr Res 2001; 49 (04) 594-599
23 Wietstock SO, Bonifacio SL, Sullivan JE, Nash KB, Glass HC. Continuous video electroencephalographic (EEG) monitoring for electrographic seizure diagnosis in neonates: a single-center study. J Child Neurol 2016; 31 (03) 328-332
24 Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33 (10) 696-705
25 Zhang W, Ma J, Danzeng Q, Tang Y, Lu M, Kang Y. Safety of moderate hypothermia for perinatal hypoxic-ischemic encephalopathy: a meta-analysis. Pediatr Neurol 2017; 74: 51-61
26 Shankaran S, McDonald SA, Laptook AR. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal magnetic resonance imaging pattern of brain injury as a biomarker of childhood outcomes following a trial of hypothermia for neonatal hypoxic-ischemic encephalopathy. J Pediatr 2015; 167 (05) 987-993
27 Murray DM, Boylan GB, Ryan CA, Connolly S. Early EEG findings in hypoxic-ischemic encephalopathy predict outcomes at 2 years. Pediatrics 2009; 124 (03) e459-e467
28 Gunn AJ, Gluckman PD, Gunn TR. Selective head cooling in newborn infants after perinatal asphyxia: a safety study. Pediatrics 1998; 102 (4, Pt 1): 885-892
29 Tooley JR, Eagle RC, Satas S, Thoresen M. Significant head cooling can be achieved while maintaining normothermia in the newborn piglet. Arch Dis Child Fetal Neonatal Ed 2005; 90 (03) F262-F266
30 Wu TW, McLean C, Friedlich P. , et al. Brain temperature in neonates with hypoxic-ischemic encephalopathy during therapeutic hypothermia. J Pediatr 2014; 165 (06) 1129-1134
31 Sarkar S, Donn SM, Bhagat I, Dechert RE, Barks JD. Esophageal and rectal temperatures as estimates of core temperature during therapeutic whole-body hypothermia. J Pediatr 2013; 162 (01) 208-210