The value of an early neurologic examination and amplitude-integrated electroencephalography (a-EEG) in the early identification of term infants at risk for persistent encephalopathy was evaluated in 52 infants enrolled prospectively with evidence of intrapartum distress at the University of Texas Southwestern Medical Center, Dallas, TX. Infants with Apgar scores <5 at 5 min or cord arterial pH <7.00, who were admitted to intensive care, had a neurologic exam at 5 +/- 3 hours after delivery, using a modified Sarnat staging system (stages 2 and 3 are abnormal) and a blinded simultaneous a-EEG measurement using a cerebral function monitor. An abnormal short-term outcome, defined as persistent moderate to severe encephalopathy beyond 5 days, was present in 14 (28%) of 50 infants. Nine (53%) of 17 infants with stage 2 encephalopathy and both infants with stage 3 had a short-term abnormal outcome. The a-EEG was abnormal in 15 (30%) infants, 11 (73%) having an abnormal outcome. A combination of abnormal neurologic exam and abnormal a-EEG had the highest specificity (94%) and positive predictive value (85%). [1]
COMMENT. A combination of neurologic exam and a-EEG shortly after birth provides the best prediction of high-risk for abnormal outcome and persistent encephalopathy. Both evaluations can be performed by clinicians at the bedside.