Somatosensory evoked potentials are of additional prognostic value in certain patterns of brain injury in term birth asphyxia

Swarte, Renate M.C.; Cherian, Perumpillichira J.; Lequin, Maarten; Visser, Gerhard H.; Govaert, Paul

doi:10.1016/j.clinph.2011.12.009

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Somatosensory evoked potentials are of additional prognostic value in certain patterns of brain injury in term birth asphyxia

Renate M.C. Swarte
- Department of Neonatology, Erasmus MC-Sophia, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands
- Corresponding author. Address: Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. Tel./fax: +31 107036837.
Perumpillichira J. Cherian
- Department of Clinical Neurophysiology, Erasmus MC, ‘sGravendijkwal 230, 3015 CE Rotterdam, The Netherlands
Maarten Lequin
- Department of Pediatric Radiology, Erasmus MC-Sophia, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands
Gerhard H. Visser
- Department of Clinical Neurophysiology, Erasmus MC, ‘sGravendijkwal 230, 3015 CE Rotterdam, The Netherlands
Paul Govaert
- Department of Neonatology, Erasmus MC-Sophia, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands

Accepted 9 December 2011. published online 20 January 2012.
Corrected Proof

Highlights

► SEPs can be of additional prognostic value to EEG and MRI in term asphyxiated newborns. ► Unilaterally abnormal SEP in combination with unilateral injury in the posterior frontal cortex due to asymmetrical watershed injury in perinatal asphyxia predicts the development of hemiparesis. ► SEPs seem to be more accurate in predicting motor than cognitive outcome.

Abstract

Objective

(a) To relate MRI patterns of brain injury to somatosensory evoked potentials (SEPs), and (b) to determine the prognostic value of SEPs in addition to continuous EEG monitoring (cEEG) and cerebral imaging, in term asphyxiated newborns.

Methods

Fifty one consecutive neonates were studied. Survivors were followed for at least 2years. cEEG, started within 24h, was done for ⩾24h and scored. SEPs and MRIs were performed in the first week. Brain injury patterns were classified.

Results

Bilaterally abnormal SEPs had a sensitivity of 90% (28/31) and specificity of 85% (17/20) in predicting a poor outcome, defined as death or severe handicap. SEPs were of particular value in predicting outcome in isolated symmetrical white matter injury and predicting the development of hemiparesis in isolated asymmetrical watershed injury. Binary logistic regression analysis revealed a significant relation to outcome separately for cEEG, deep grey matter injury on MRI and SEPs. SEPs provided additional value when added to cEEG and MRI in the model (p=0.034).

Conclusions

SEPs are of additional prognostic value after term birth asphyxia.

Significance

In certain patterns of postasphyxial neonatal brain injury like asymmetrical watershed lesions and symmetrical white matter injury, EPs are complementary to information obtained from cEEG and MRI for prognostication.

Keywords: SEP, Asphyxia, Brain injury, MRI patterns, Neonates, Outcome