Multimodal Neuromonitoring in Neonatal Hypoxic-Ischemic Encephalopathy and the Association with Neurodevelopmental Outcomes: A Multicenter Study.
prospective_cohort · Level II
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- Also identified by DOI 10.1016/j.jpeds.2026.115222.
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Abstract
To assess in neonates with hypoxic-ischemic encephalopathy (HIE) whether multimodal neuromonitoring, using near-infrared spectroscopy and amplitude-integrated electroencephalography (aEEG), correlates with cerebral injury observed on brain magnetic resonance imaging (MRI) as well as neurodevelopmental outcome (NDO). Neonates born at >35 weeks and >1800 g undergoing therapeutic hypothermia were included in this prospective-retrospective, multicenter study. The aEEG pattern, cerebral tissue oxygenation (rScO<sub>2</sub>), burden of rScO<sub>2</sub>≥95%, arterial blood pressure, heart rate, and cerebrovascular autoregulation were monitored during therapeutic hypothermia and rewarming from 0 to 24, 24 to 48, 48 to 72, and 72 to 96 hours. Early cerebral MRI was assessed using a validated quali-quantitative score. NDO was assessed using Bayley Scales of Infant Development cognitive and motor scores at 24 months. In 128 neonates with a median Thompson score of 9, greater seizure burden (beta coefficient, B<sub>24-48h</sub> = 3.21, 95% CI limits, 95%CI [2.01, 4.41]), absent sleep-wake-cycling (B<sub>24-48h</sub> = -5.53, 95%CI [-8.29, -2.77]), and a higher burden of rScO<sub>2</sub>≥95% (B<sub>0-24h</sub> = 0.34, 95%CI [0.07, 0.61]) were associated with worse cerebral injury on MRI. Cognitive and motor scores inversely correlated with aEEG abnormalities, rScO<sub>2</sub>, burden of rScO<sub>2</sub>≥95%, and absent sleep-wake-cycling, whereas higher arterial blood pressures between 0 and 24 hours were associated with higher NDO scores. Combined abnormal aEEG characteristics and rScO<sub>2</sub>, but not cerebrovascular autoregulation assessed as cerebral oximetry index or tissue oxygenation heart rate-reactivity index, correlated significantly with brain injury on MRI and NDO after hypoxic-ischemic encephalopathy. These findings provide valuable clinical information and, in future studies, may support identification of infants who might benefit from adjuvant therapies.