# Progression of Amplitude-Integrated Electroencephalography and Neurological Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy: A Single-Institution Cohort Study in Vietnam

## TL;DR

This study tracks aEEG patterns in Vietnamese neonates with HIE during hypothermia and finds that specific aEEG features predict neurological outcomes.

## Contribution

The study provides new insights into aEEG progression during hypothermia and its predictive value for neurological outcomes in HIE neonates.

## Key findings

- 75.7% of HIE infants showed improved aEEG background activity during hypothermia.
- Lack of sleep-wake cycles and prolonged time to normal aEEG were linked to poor outcomes.
- 70.3% of infants exhibited seizure activity on aEEG during monitoring.

## Abstract

Background

The characteristics of amplitude-integrated electroencephalography (aEEG) are associated with neurological outcomes in neonates with hypoxic-ischemic encephalopathy (HIE). We perform a longitudinal analysis of continuous monitoring of aEEG during therapeutic hypothermia and explore the association between aEEG interpretation and clinical neurological outcomes.

Method

We conducted a prospective cohort study on HIE neonates undergoing hypothermia with aEEG monitoring.

Results

A total of 37 HIE infants underwent hypothermia with improved aEEG background activity in 28 (75.7%) neonates, of which 18 (48.6%) neonates had background activity returned to a continuous pattern, and the median recovery time was 26.5 hours. Sleep-wake cycle (SWC) appeared in 14 (37.8%) cases, with a median onset time of 34.5 hours. Seizure activity on aEEG was present in 26 (70.3%) infants. Factors associated with poor outcomes at discharge included low voltage or flat trace background activity, a lack of improvement in background activity after hypothermia, and the absence of SWC. Neonates who took longer than 62 hours to return to continuous background activity (time to normal trace) or did not have SWC before the end of hypothermia were more likely to have unfavorable outcomes at discharge.

Conclusions

Longitudinal analysis of aEEG during hypothermia should be implemented in neonatal care units. The progression of these features on aEEG may predict neurological outcomes for HIE neonates.