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May 2018 - Katharina Goeral

Dr. Katharina Goeral (Göral)


Prediction of Outcome in Neonates with Hypoxic-Ischemic Encephalo-pathy II: Role of Amplitude-Integrated Electroencephalography and Cerebral Oxygen Saturation Measured by Near-Infrared Spectroscopy

Background: Few data have been published on the combined use of amplitude-integrated electroencephalography (aEEG) and near-infrared spectroscopy (NIRS) for outcome prediction in neonates cooled for hypoxic-ischemic encephalopathy (HIE).

Objective: Our aim was to evaluate predictive values and most powerful predictive combinations of single aEEG and NIRS parameters and respective cut-off values with regard to short-term outcome  in HIE II.

Methods: aEEG and NIRS were prospectively studied at the Medical University of Vienna in the first 102 hrs of life with regard to MRI.

Thirty-two neonates diagnosed with HIE II treated with hypothermia were investigated. The measurement period was divided into six hour epochs. According to MRI, two outcome groups were defined and predictive values of aEEG parameters, regional cerebral oxygen saturation (rScO2), and the additional value of both methods combined were studied. Receiver-operating curves (ROCs) were obtained and area under the curve (AUC) values were calculated. ROCs were then used to detect optimal cut-off points, sensitivity, specificity, PPV and NPV.

Results: At all time epochs, combined parameter scores were more predictive than single parameter scores. Highest AUCs were observed between 18-60hrs of cooling for an aEEG summation score (0.72-0.84) and for ‘(background pattern+seizures)*rScO2’ (0.79-0.85). At 42-60hrsm, sensitivity was similar between those two scores (87.5-90.0%), but the addition of NIRS to aEEG led to an increase in specificity (from 52.4-59.1% to 72.7-90.5%).

Conclusions: In HIE II, aEEG and NIRS are important predictors of short-term outcome in Neonates with Hypoxic-Ischemic Encephalopathy. The combination of both methods improves prognostication. Highest predictive abilities were observed between 18-60hrs of cooling.

Selected Literature

  1. Wagner M, Olischar M, O'Reilly M, Goeral K, Berger A, Cheung PY, Schmölzer GM. Review of Routes to Administer Medication During Prolonged Neonatal Resuscitation. Pediatr Crit Care Med. 2018 Feb 5. DOI:10.1097/PCC.0000000000001493.
  2. Rittenschober-Böhm J, Waldhoer T, Schulz SM, Stihsen B, Pimpel B, Goeral K, Hafner E, Sliutz G, Kasper DC, Witt A, Berger A. First Trimester Vaginal Ureaplasma Biovar Colonization and Preterm Birth: Results of a Prospective Multicenter Study. Neonatology. 2017 Sep 22;113(1):1-6. DOI:10.1159/000480065.
  3. Goeral K, Urlesberger B, Giordano V, Kasprian G, Wagner M, Schmidt L, Berger A, Klebermass-Schrehof K, Olischar M. Prediction of Outcome in Neonates with Hypoxic-Ischemic Encephalopathy II: Role of Amplitude-Integrated Electroencephalography and Cerebral Oxygen Saturation Measured by Near-Infrared Spectroscopy. Neonatology. 2017 March 8. . DOI:10.1159/000468976.
  4. Klebermass-Schrehof K, Aumüller S, Goeral K, Vergesslich-Rothschild K, Fuiko R, Brandstetter S, Berger A, Jilma B, Haiden N. Biometry of the corpus callosum assessed by 3D-ultrasound and its correlation to neurodevelopmental outcome in very low birth weight infants. J Perinatol. 2016 Dec 15. DOI:10.1038/jp.2016.231.
  5. Wagner M, Mileder LP, Goeral K, Klebermass-Schrehof K, Cardona FS, Berger A, Schmölzer G, Olischar M. Student peer teaching in paediatric simulation training is a feasible low-cost alternative for education. Acta Paediatrica: Nurturing the Child. 2017 Jun; 106(6):995-1000. DOI:10.1111/apa.13792.
  6. Breu M, Zhang J, Porambo M, Pletnikov M, Goeral K, Kakara M, Johnston M, Fatemi A. Diffusion Tensor Imaging Abnormalities in Cerebral White Matter Correlate with Sex-Dependent Neurobehavioral Deficits in Adult Mice with Neonatal Ischemia. Dev Neurosci. 2016;38(2):83-95. DOI:10.1159/000442943.
  7. Falahati S, Breu M, Waickman AT, Phillips AW, Arauz EJ, Snyder S, Porambo M, Goeral K, Comi AM, Wilson MA, Johnston MV, Fatemi A. Ischemia-induced neuroinflammation is associated with disrupted development of oligodendrocyte progenitors in a model of periventricular leukomalacia. Dev Neurosci. 2013;35(2-3):182-96. DOI:10.1159/000346682.

Dr. Katharina Goeral

Medizinische Universität Wien
Univ. Klinik für Kinder- und Jugendheilkunde
Abteilung für Neonatologie, pädiatrische Intensivmedizin und Neuropädiatrie
A-1090 Wien, Währinger Gürtel 18-20

Tel.: +43 (0)1 40400-29300