PREDICTIVE VALUE OF NEONATAL ELECTROENCEPHALOGRAMS BEFORE AND DURING EXTRACORPOREAL MEMBRANE-OXYGENATION

We studied the prognostic significance of electroencepholograms record ed serially at 2- to 4-day intervals during the acute neonatal course of 119 near-term infants with severe respiratory failure treated by ve noarterial extracorporeal membrane oxygenation (ECMO). A poor prognosi s was defined as early death (n = 27), an abnormally low developmental assessment score (n = 14), or cerebral palsy (n = 14) at 12 to 45 mon ths of age. The only electroencephalographic abnormalities that were s ignificantly related to a poor prognosis were burst suppression (B-S) and electrographic seizure (ES). The 30 infants with two or more recor dings of B-S or ES, when compared with the 58 neonates without such el ectroencephalographic abnormalities, had an odds ratio for a poor prog nosis of 6.6 (95% confidence limits, 2.2 to 20.2). The 31 infants with a single ES or B-S recording did not have a significantly increased r isk for a poor prognosis. Cardiopulmonary resuscitation immediately be fore ECMO (n = 8) and the lowest systolic blood pressure before or dur ing ECMO were significantly related to the occurrence of ES or B-S rec ordings. There was no significant predilection of ES for either cerebr al hemisphere. We conclude that in near-term neonates with respiratory failure, serial electroencephalographic recordings are of predictive value, and may facilitate clinical care including the decision to init iate or to continue ECMO.