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Early Amplitude-Integrated Electroencephalography Predicts Long-Term Outcomes in Term and Near-Term Newborns With Severe Hyperbilirubinemia

Journal article
Authors X. Yuan
J. Song
L. Gao
Y. C. Cheng
H. M. Dong
R. L. Zhang
S. S. Liu
X. Ding
Y. Wang
F. L. Xu
Changlian Zhu
Published in Pediatric Neurology
Volume 98
Pages 68-73
ISSN 0887-8994
Publication year 2019
Published at Institute of Neuroscience and Physiology
Pages 68-73
Language en
Keywords Amplitude-integrated electroencephalography, Auditory brainstem response, Bilirubin, acute bilirubin encephalopathy, neuropathy spectrum disorder, neonatal, hyperbilirubinemia, auditory neuropathy, late preterm, infants, management, system, toxicity, damage, Neurosciences & Neurology, Pediatrics
Subject categories Pediatrics, Neurosciences


Background: We aimed to determine the predictive neurological prognostic value of early amplitude-integrated electroencephalography (aEEG) in term and near-term neonates with severe hyperbilirubinemia compared with cranial magnetic resonance imaging (MRI) and auditory brainstem response (ABR). Methods: Infants of >= 35 weeks of gestation with severe hyperbilirubinemia (total serum bilirubin [TSB] 340 mu mol/L) or with hyperbilirubinemia (TSB >= 257 mu mol/L) in association with bilirubin-induced neurological dysfunction were recruited. All the subjects had an aEEG after being admitted to the neonatal intensive care unit, whereas cranial MRI and ABR were performed when TSB had come down to the normal range. All the infants were followed up to 12 months. Results: During the study period, 77 of 83 infants were eligible, of which 71 had severe hyperbilirubinemia and six had hyperbilirubinemia in association with bilirubin-induced neurological dysfunction. Thirty-three infants were diagnosed with acute bilirubin encephalopathy (ABE), two of whom died of ABE, and 62 completed the follow-up, of which 12 infants had adverse outcomes. Sixtyfour infants underwent aEEG, 40 infants had cranial MRI, and 39 infants had ABR. Logistic regression and the receiver-operator characteristic curve analysis showed that the ability of severely abnormal aEEG to predict adverse neurological outcomes in severe hyperbilirubinemia was no better than abnormal ABR, with a sensitivity of 35.7% versus 83.3%, a specificity of 92.0% versus 74.1%, a positive predictive value of 55.6% versus 58.8%, and a negative predictive value of 83.6% versus 90.9%. Conclusions: Early aEEG could predict adverse neurodevelopmental outcomes in neonates with severe hyperbilirubinemia, although the sensitivity was lower than ABR. (C) 2019 The Authors. Published by Elsevier Inc.

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