Characteristics of seizures and anticonvulsant administration in each neonate.

<p>Vertical red lines denote the presence of electrographic-only seizures, vertical blue lines denote electroclinical seizures and vertical green lines denote obscured seizures. Horizontal black line denotes the period of EEG monitoring. Black crosses denote missing data. Timepoints bounded by black arrows denote the first-line anticonvulsant administration while the magenta arrows denote the second-line anticonvulsant administration.</p

Demographics and neuroimaging features of neonates in the order of increasing seizure burden.

<p>EMCS, emergency Caesarean section; FTP, failure to progress; LLL, left lower limb clonic; LMCA, left middle cerebral artery; LPCA, left posterior cerebral artery; LS, left-sided clonic; LUL, left upper limb clonic movements; NRCTG, non-reassuring cardiotocogram; PROM, premature rupture of membranes; RMCA, right middle cerebral artery; RS, right-sided clonic; RUL, right upper limb clonic; VV, vertex vaginal.</p

Characteristics of EEG and seizures.

<p>Subtle seizures: C, cycling movements of the limbs; D, desaturations; M, mouthing and smacking; S, sucking; Y, yawning.</p

A. EEG in a neonate (case 6).

<p>Seizures arising from the left hemisphere corresponding with a left middle cerebral artery infarction on cranial MRI. <b>B. Cranial MRI in a neonate (case 6).</b> The sequence is an axial T2 turbo spin echo performed on day 7 of life. Note the characteristic focal spike and wave discharges over the left hemisphere with phase reversal over the left central region.</p

Table1_Heart rate variability analysis for the prediction of EEG grade in infants with hypoxic ischaemic encephalopathy within the first 12 h of birth.docx

Background and aimsHeart rate variability (HRV) has previously been assessed as a biomarker for brain injury and prognosis in neonates. The aim of this cohort study was to use HRV to predict the electroencephalography (EEG) grade in neonatal hypoxic-ischaemic encephalopathy (HIE) within the first 12 h.MethodsWe included 120 infants with HIE recruited as part of two European multi-centre studies, with electrocardiography (ECG) and EEG monitoring performed before 12 h of age. HRV features and EEG background were assessed using the earliest 1 h epoch of ECG-EEG monitoring. HRV was expressed in time, frequency and complexity features. EEG background was graded from 0-normal, 1-mild, 2-moderate, 3-major abnormalities to 4-inactive. Clinical parameters known within 6 h of birth were collected (intrapartum complications, foetal distress, gestational age, mode of delivery, gender, birth weight, Apgar at 1 and 5, assisted ventilation at 10 min). Using logistic regression analysis, prediction models for EEG severity were developed for HRV features and clinical parameters, separately and combined. Multivariable model analysis included 101 infants without missing data.ResultsOf 120 infants included, 54 (45%) had normal-mild and 66 (55%) had moderate-severe EEG grade. The performance of HRV model was AUROC 0.837 (95% CI: 0.759–0.914) and clinical model was AUROC 0.836 (95% CI: 0.759–0.914). The HRV and clinical model combined had an AUROC of 0.895 (95% CI: 0.832–0.958). Therapeutic hypothermia and anti-seizure medication did not affect the model performance.ConclusionsEarly HRV and clinical information accurately predicted EEG grade in HIE within the first 12 h of birth. This might be beneficial when EEG monitoring is not available in the early postnatal period and for referral centres who may want some objective information on HIE severity.</p