TY - JOUR
T1 - Brain Activity and Cerebral Oxygenation After Perinatal Arterial Ischemic Stroke Are Associated With Neurodevelopment
AU - Wagenaar, Nienke
AU - van den Berk, Daphne J. M.
AU - Lemmers, Petra M. A.
AU - van der Aa, Niek E.
AU - Dudink, Jeroen
AU - van Bel, Frank
AU - Groenendaal, Floris
AU - de Vries, Linda S.
AU - Benders, Manon J. N. L.
AU - Alderliesten, Thomas
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background and Purpose—In infants with perinatal arterial ischemic stroke (PAIS), early prognosis of neurodevelopmental outcome is important to adequately inform parents and caretakers. Early continuous neuromonitoring after PAIS may improve early prognosis. Our aim was to study early cerebral electrical activity and oxygenation measured by amplitude-integrated electroencephalography (aEEG) and near-infrared spectroscopy in term neonates with PAIS and relate these to the development of cerebral palsy and cognitive deficit. Methods—aEEG patterns and regional cerebral oxygen saturation (rScO
2) levels of both hemispheres were studied for 120 hours from the first clinical symptoms of PAIS (ie, seizures) onward. Multivariable analyses were used to investigate the association between aEEG, near-infrared spectroscopy, clinical variables, and neurodevelopmental outcome. Results—In 52 patients with PAIS (gestational age, 40.4±1.4 weeks; birth weight, 3282±479 g), median time to a continuous background pattern was longer in the ipsilesional compared with the contralesional hemisphere (13.5 versus 10.0 hours; P<0.05). rScO
2 decreased over time in both hemispheres but less in the ipsilesional one, resulting in a rScO
2 asymmetry ratio of 4.5% (interquartile range, −4.3% to 5.9%; P<0.05) between hemispheres from day 3 after symptoms onward. Both time to normal background pattern and asymmetry in rScO
2 were negatively affected by gestational age, size of the PAIS, use of antiepileptic drugs, and mechanical ventilation. After correction for size of the PAIS on magnetic resonance imaging, a slower recovery of background pattern on ipsilesional aEEG and increased rScO
2 asymmetry between hemispheres was related with an increased risk for cognitive deficit (<−1 SD) at a median of 24.0 (interquartile range, 18.4–24.4) months of age. Conclusions—Recovery of background pattern on aEEG and cerebral oxygenation are both affected by PAIS and related to neurocognitive development. Both measurements may provide valuable early prognostic information. Additionally, monitoring cerebral activity and oxygenation may be useful in identifying infants eligible for early neuroprotective interventions and to detect early effects of these interventions.
AB - Background and Purpose—In infants with perinatal arterial ischemic stroke (PAIS), early prognosis of neurodevelopmental outcome is important to adequately inform parents and caretakers. Early continuous neuromonitoring after PAIS may improve early prognosis. Our aim was to study early cerebral electrical activity and oxygenation measured by amplitude-integrated electroencephalography (aEEG) and near-infrared spectroscopy in term neonates with PAIS and relate these to the development of cerebral palsy and cognitive deficit. Methods—aEEG patterns and regional cerebral oxygen saturation (rScO
2) levels of both hemispheres were studied for 120 hours from the first clinical symptoms of PAIS (ie, seizures) onward. Multivariable analyses were used to investigate the association between aEEG, near-infrared spectroscopy, clinical variables, and neurodevelopmental outcome. Results—In 52 patients with PAIS (gestational age, 40.4±1.4 weeks; birth weight, 3282±479 g), median time to a continuous background pattern was longer in the ipsilesional compared with the contralesional hemisphere (13.5 versus 10.0 hours; P<0.05). rScO
2 decreased over time in both hemispheres but less in the ipsilesional one, resulting in a rScO
2 asymmetry ratio of 4.5% (interquartile range, −4.3% to 5.9%; P<0.05) between hemispheres from day 3 after symptoms onward. Both time to normal background pattern and asymmetry in rScO
2 were negatively affected by gestational age, size of the PAIS, use of antiepileptic drugs, and mechanical ventilation. After correction for size of the PAIS on magnetic resonance imaging, a slower recovery of background pattern on ipsilesional aEEG and increased rScO
2 asymmetry between hemispheres was related with an increased risk for cognitive deficit (<−1 SD) at a median of 24.0 (interquartile range, 18.4–24.4) months of age. Conclusions—Recovery of background pattern on aEEG and cerebral oxygenation are both affected by PAIS and related to neurocognitive development. Both measurements may provide valuable early prognostic information. Additionally, monitoring cerebral activity and oxygenation may be useful in identifying infants eligible for early neuroprotective interventions and to detect early effects of these interventions.
KW - Brain/blood supply
KW - Cohort Studies
KW - Electroencephalography
KW - Female
KW - Humans
KW - Infant
KW - Infant, Newborn
KW - Infant, Newborn, Diseases
KW - Male
KW - Neurodevelopmental Disorders/etiology
KW - Oxygen/metabolism
KW - Retrospective Studies
KW - Spectroscopy, Near-Infrared
KW - Stroke/complications
UR - http://www.scopus.com/inward/record.url?scp=85072628974&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.119.025346
DO - 10.1161/STROKEAHA.119.025346
M3 - Article
C2 - 31390967
SN - 0039-2499
VL - 50
SP - 2668
EP - 2676
JO - Stroke
JF - Stroke
IS - 10
ER -