Delayed Onset of Sleep-Wake Cycling with Favorable Outcome in Hypothermic-Treated Neonates with Encephalopathy

• Published in: The Journal of pediatrics Vol. 159; no. 2; pp. 232 - 237
• Main Authors: Takenouchi, Toshiki, MD, Rubens, Elayna O., MD, Yap, Vivien L., MD, Ross, Gail, PhD, Engel, Murray, MD, Perlman, Jeffrey M., MBChB
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Elsevier Inc 01.08.2011; Elsevier
• Subjects: Biological and medical sciences; Brain - physiopathology; Circadian Rhythm - physiology; Electroencephalography; Follow-Up Studies; General aspects; Humans; Hypothermia, Induced - methods; Hypoxia-Ischemia, Brain - diagnosis; Hypoxia-Ischemia, Brain - physiopathology; Hypoxia-Ischemia, Brain - therapy; Infant; Infant, Newborn; Magnetic Resonance Imaging; Medical sciences; Pediatrics; Prognosis; Retrospective Studies; Sleep - physiology; Time Factors; Treatment Outcome; Wakefulness - physiology; Amplitude-integrated electroencephalogram; HIE; MRI; Negative predictive value; vEEG; Mental Developmental Index; aEEG; Video electroencephalogram; MDI; Magnetic resonance imaging; NPV; PPV; Positive predictive value; Hypoxic-ischemic encephalopathy; Human; Pediatrics; Nervous system diseases; Prognosis; Variations; Delay; Cerebral disorder; Newborn; Sleep; Treatment; Age of onset; Encephalopathy; Central nervous system disease; Evolution; Sleep wake cycle
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2011.01.006

Objective To determine whether hypothermia modulates acquisition of sleep-wake cycling in term neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE) and the relationship to outcome. Study design Twenty-nine term infants with moderate to severe HIE treated with selective head cooling were evaluated. All were monitored with amplitude-integrated electroencephalography during and video electroencephalography immediately after hypothermia for ≥72 hours. Electroencephalograpic data were analyzed for background and sleep-wake cycling. Abnormal outcome included death or severe global neurodevelopmental disability ≥18 months. Results Acquisition of sleep-wake cycling was noted in nine infants by 72 hours, in 13 by 96 hours, 19 by 120 hours, and 22 by 144 hours. Presence of sleep-wake cycling was associated with normal outcome, that is, 14 of 22 (64%), versus abnormal outcome, that is, none of seven without sleep-wake cycling ( P = .006). The presence of sleep-wake cycling by 120 hours had a positive predictive value of 68% and negative predictive value of 90%. Magnetic resonance imaging abnormalities were related to onset of sleep-wake cycling. Conclusions Although onset of sleep-wake cycling is markedly delayed in term neonates with moderate to severe HIE treated with hypothermia, approximately 65% with acquisition of cycling have a normal outcome. Sleep-wake cycling is an important additional tool for assessing recovery in term infants with moderate to severe HIE treated with hypothermia.