Multimodal Neuromonitoring in Neonatal Hypoxic-Ischemic Encephalopathy and the Association with Neurodevelopmental Outcomes: A Multicenter Study

OBJECTIVE: To assess in neonates with hypoxic-ischemic encephalopathy (HIE) whether multimodal neuromonitoring, using near-infrared spectroscopy and amplitude-integrated electroencephalography (aEEG), correlates with cerebral injury observed on brain magnetic resonance imaging (MRI) as well as neurodevelopmental outcome (NDO). STUDY DESIGN: ≥95%, arterial blood pressure, heart rate, and cerebrovascular autoregulation were monitored during therapeutic hypothermia and rewarming from 0 to 24, 24 to 48, 48 to 72, and 72 to 96 hours. Early cerebral MRI was assessed using a validated quali-quantitative score. NDO was assessed using Bayley Scales of Infant Development cognitive and motor scores at 24 months. RESULTS: ≥95%, and absent sleep-wake-cycling, whereas higher arterial blood pressures between 0 and 24 hours were associated with higher NDO scores. CONCLUSIONS: , but not cerebrovascular autoregulation assessed as cerebral oximetry index or tissue oxygenation heart rate-reactivity index, correlated significantly with brain injury on MRI and NDO after hypoxic-ischemic encephalopathy. These findings provide valuable clinical information and, in future studies, may support identification of infants who might benefit from adjuvant therapies.