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Am J Perinatol 2024; 41(S 01): e1681-e1688
DOI: 10.1055/s-0043-1768487
Original Article

The Impact of Phenobarbital on the Ability of Electroencephalogram to Predict Adverse Outcome in Asphyxiated Neonates during Therapeutic Hypothermia

Asri Yuliati
1   Division of Pediatric Neurology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
,
Michael Zayek
2   Department of Pediatrics, Division of Neonatology, University of South Alabama, Mobile, Alabama
,
Paul Maertens
1   Division of Pediatric Neurology, Department of Pediatrics, University of South Alabama, Mobile, Alabama
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Funding None.
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Abstract

Objective Classification of electroencephalogram (EEG) background has been established to predict outcome in neonates with hypoxic ischemic encephalopathy (HIE). However, the impact of phenobarbital therapy on the predictability of EEG background has not been studied. Our objective is to determine if EEG background after treatment with phenobarbital during therapeutic hypothermia (TH) remains a good predictor for brain injury in neonates with HIE.

Study Design This is a single-center, retrospective study of consecutive neonates with HIE who underwent TH and EEG monitoring from October 2017 to March 2021. Per institutional protocol, all infants received a dose of prophylactic phenobarbital and bumetanide therapy at the onset of TH for sedative and neuroprotective measures. The initial 3 hours of EEG background activity was classified based on national guidelines. Infants were separated into two groups based on EEG background scores: group 1 (normal–mild, n = 30) and group 2 (moderate–severe, n = 36). Brain magnetic resonance imaging (MRI) results were scored based on the National Institute of Child Health and Human Development (NICHD) criteria. Adverse outcomes were defined as death before MRI or NICHD brain injury score > 1A.

Results Infants in group 2 had lower Apgar scores at 5 minutes of age, severe acidemia, moderate to severe encephalopathy score, and earlier initiation of EEG monitoring than infants in group 1. Moderate to severe EEG background score was associated with presence of brain injury on MRI or death (p = 0.003), and this association remained significant even after adjustment for independent risk factors (odds ratio = 56.24 [95% confidence interval = 1.841–1718], p = 0.021).

Conclusion Phenobarbital therapy does not affect the ability of EEG to predict adverse outcome in infants with perinatal asphyxia during TH.

Key Points

  • EEG has a clinical utility for predicting outcome in neonates with hypoxia–ischemia.

  • Phenobarbital therapy is commonly used in neonates, and may impact EEG background findings.

  • In spite phenobarbital therapy, moderate to severe EEG background abnormalities in infants with perinatal asphyxia during TH remain an excellent predictor for poor outcome.

Keywords

hypoxic ischemic encephalopathy - therapeutic hypothermia - phenobarbital - EEG background - brain injury

Authors' Contributions

A.Y.: conception and design of the study, data collection, interpretation of data, and draft of the manuscript; M.Z.: data statistical analysis, tables and figure, interpretation of data, reviewed and revised the manuscript; P.M.: providing the patient cohort data, reviewed and revised the manuscript.


Note

The earlier version of this manuscript has been presented as a poster presentation at the AES Annual Meeting 2021 in Chicago, at December 5, 2021.




Publication History

Received: 25 July 2022

Accepted: 23 March 2023

Article published online:
26 April 2023

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