Ability of early neurological assessment and continuous EEG to predict long term neurodevelopmental outcome at 5 years in infants following hypoxic-ischaemic encephalopathy

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dc.contributor.advisor Murray, Deirdre M. en
dc.contributor.advisor Boylan, Geraldine B. en
dc.contributor.author O'Connor, Catherine M.
dc.date.accessioned 2019-11-13T10:32:24Z
dc.date.issued 2018
dc.date.submitted 2018
dc.identifier.citation O'Connor, C. M. 2018. Ability of early neurological assessment and continuous EEG to predict long term neurodevelopmental outcome at 5 years in infants following hypoxic-ischaemic encephalopathy. PhD Thesis, University College Cork. en
dc.identifier.endpage 300 en
dc.identifier.uri http://hdl.handle.net/10468/8996
dc.description.abstract Hypoxic-ischaemic encephalopathy (HIE) symptoms evolve during the first days of life and their monitoring is critical for treatment decisions and long-term outcome predictions. This thesis aims to report the five-year outcome of a HIE cohort born in the pre-therapeutic hypothermia era and to evaluate the predictive value of (a) neonatal neurological and EEG markers and (b) development in the first 24 months, for outcome. Methods: Participants were recruited at age five from two birth cohorts; HIE and Comparison. Repeated neonatal neurological assessments using the Amiel-TisonNeurological-Assessment-at-Term, continuous video EEG monitoring in the first 72 hours, and Sarnat grading at 24 hours were recorded. EEG severity grades were assigned at 6, 12 and 24 hours. Development was assessed in the HIE cohort at 6, 12 and 24 months using the Griffiths Mental Development (0-2) Revised Scales. At age five, intellectual (WPPSI-IIIUK scale), neuropsychological (NEPSY-II scales), neurological and ophthalmic testing was completed. Results: 5-year outcomes were available for 81.5% (n=53) of HIE and 71.4% (n=30) of Comparison cohorts. In HIE, 47.2% (27% mild, 47% moderate, 83% severe Sarnat), had non-intact outcome vs. 3.3% of the Comparison cohort. Non-intact outcome rates by 6-hour EEG-grade were: grade0=3%, grade1=25%, grade2=54%, grade3/4=79%. In HIE, processing speed (p=0.01) and verbal short-term memory (p=0.005) were below test norms. No significant differences were found in IQ, NEPSY-II or ocular biometry scores between children following mild and moderate HIE. Median IQ scores for mild (99(94-112),p=grade 2) at 24hours had superior positive predictive value (74%; AUROC(95%CI)=0.70(0.55-0.85) for non-intact 5-year outcome than abnormal EEG at 6 hours (68%; AUROC(95%CI)=0.71(0.56-0.87). Within-child development scores were inconsistent across the first 24 months. Although all children with intact 24-month Griffiths quotient (n=30) had intact 5-year IQ, 8/30 had non-intact overall outcome. Conclusion: Predictive value of neonatal neurological assessments and an EEG grading system for outcome was confirmed. Intact early childhood outcomes post-HIE may mask subtle adverse neuropsychological sequelae into the school years. This thesis supports emerging evidence that mild-grade HIE is not a benign condition and its inclusion in studies of neuroprotective treatments for HIE is warranted. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher University College Cork en
dc.rights © 2018, Catherine M. O'Connor. en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/ en
dc.subject Sarnat grade en
dc.subject Hypoxic-ischaemic encephalopathy en
dc.subject Neonatal encephalopathy en
dc.subject Neonatal EEG en
dc.subject Neurodevelopment en
dc.subject Childhood outcome en
dc.subject Neuropsychology en
dc.title Ability of early neurological assessment and continuous EEG to predict long term neurodevelopmental outcome at 5 years in infants following hypoxic-ischaemic encephalopathy en
dc.type Doctoral thesis en
dc.type.qualificationlevel Doctoral en
dc.type.qualificationname PhD en
dc.internal.availability Full text not available en
dc.check.info Restricted to everyone for one year en
dc.check.date 2021-11-12T10:32:24Z
dc.description.version Accepted Version
dc.contributor.funder Health Research Board en
dc.description.status Not peer reviewed en
dc.internal.school Paediatrics and Child Health en
dc.check.reason This thesis contains data which has not yet been published en
dc.check.opt-out Not applicable en
dc.thesis.opt-out false
dc.check.chapterOfThesis 6
dc.check.embargoformat Apply the embargo to the e-thesis on CORA (If you have submitted an e-thesis and want to embargo it on CORA) en
ucc.workflow.supervisor d.murray@ucc.ie
dc.internal.conferring Autumn 2019 en
dc.internal.ricu Irish Centre for Fetal and Neonatal Translational Research en
dc.relation.project Health Research Board (HRB RP/2008/238; HRB CRT/2008/31) en

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© 2018, Catherine M. O'Connor. Except where otherwise noted, this item's license is described as © 2018, Catherine M. O'Connor.
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