Background: To improve the objective assessment of continuous video-EEG (cEEG) monitoring of neonatal brain function, the aim was to relate automated derived amplitude and duration parameters of the suppressed periods in the EEG background (dynamic Interburst Interval= dIBIs) after neonatal hypoxic-ischemic encephalopathy (HIE) to favourable or adverse neurodevelopmental outcome. Methods: Nineteen neonates (gestational age 36-41 weeks) with HIE underwent therapeutic hypothermia and had cEEG-monitoring. EEGs were retrospectively analyzed with a previously developed algorithm to detect the dynamic Interburst Intervals. Median duration and amplitude of the dIBIs were calculated at 1h-intervals. Sensitivity and specificity of automated EEG background grading for favorable and adverse outcomes were assessed at 6h-intervals. Results: Dynamic IBI values reached the best prognostic value between 18 and 24h (AUC of 0.93). EEGs with dIBI amplitude ≥15 μV and duration <10s had a specificity of 100% at 6-12h for favorable outcome but decreased subsequently to 67% at 25-42h. Suppressed EEGs with dIBI amplitude <15μV and duration >10s were specific for adverse outcome (89-100%) at 18-24h (n = 10). Extremely low voltage and invariant EEG patterns were indicative of adverse outcome at all time points. Conclusions: Automated analysis of the suppressed periods in EEG of neonates with HIE undergoing TH provides objective and early prognostic information. This objective tool can be used in a multimodal strategy for outcome assessment. Implementation of this method can facilitate clinical practice, improve risk stratification and aid therapeutic decision-making. A multicenter trial with a quantifiable outcome measure is warranted to confirm the predictive value of this method in a more heterogeneous dataset.

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Keywords automated EEG analysis, dynamic Interburst Interval, hypoxic-ischemic encephalopathy, outcome prediction
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Journal Pediatrics and Neonatology
Dereymaeker, A. (Anneleen), Matić, V, Vervisch, J. (Jan), Cherian, P.J, Ansari, A.H, De Wel, O. (Ofelie), … Jansen, K. (2018). Automated EEG background analysis to identify neonates with hypoxic-ischemic encephalopathy treated with hypothermia at risk for adverse outcome: A pilot study. Pediatrics and Neonatology. doi:10.1016/j.pedneo.2018.03.010