ORIGINAL ARTICLE The prognostic value of serial EEG recordings following acute neonatal asphyxia in full-term infants ESTHER ZEINSTRA, 1 JOHANNA M FOCK, 1 JACOBUS H BEGEER, 1 TIEMEN W VAN WEERDEN, 2 NATASHA M MAURITS, 2 MARIANNA J ZWEENS 3 1 Department of Paediatric Neurology, 2 Department of Clinical Neurophysiology, 3 Department of Paediatrics, University Hospital Groningen, Groningen, The Netherlands Perinatal asphyxia is one of the major causes of non-progressive neurological deficits seen in children. It is reported that currently no set of parameters allowing for accurate prediction of prognosis following severe perinatal asphyxia is available. Even electroencephalogram EEG) recordings, which are known to give a fairly good prediction of long- term outcome, have their flaws. The aim of this prospective study was to evaluate the additional value of serial EEGs in full-term infants. In all, 36 infants were enrolled. All met strict entrance criteria, received standard treatment and underwent two EEGs according to a pre-set protocol: the first between 12 and 36 hours post-partum, the second between 7 and 9 days post-partum. It is clearly demonstrated that serial EEG recordings do enhance the prognostic value of the EEG. Moreover, distinct progression seen in serial EEGs is highly prognostic for a normal outcome and has even more prognostic value than one single severely abnormal EEG. A better indication of future outcome is obtained from serial EEGs. Keywords: Serial EEG. Asphyxia. Prognostic value. Introduction Perinatal asphyxia is one of the major causes of non-progressive neurological deficits seen in children. In a clinical setting, where drastic choices have to be made regarding continuing or terminat- ing treatment, it is of the utmost importance to have a set of parameters to predict accurately the long-term outcome. Prediction of the long-term neurological outcome has been attempted with a variety of techniques including Apgar scores, 1 neurological examina- tion, 2 neuroimaging 3 and neurophysiological evaluation. 3±7 In the neonatal period electro- encephalogram EEG) recordings are known to give a fairly good prediction of the long-term outcome; both normal and severely abnormal recordings are considered highly prognostic. Uncertainty still exists about the prognostic value of mildly abnormal EEGs. It seems self-evident that serial recordings will have greater predictive potential than one single EEG. Some EEGs, however, are considered so severely abnormal, that prediction of prognosis can be based on one single EEG. Some authors report serial EEGs to be useful to prognosticate the clinical outcome, for example in preterm infants or in mildly abnormal EEGs. 8±10 The purpose of this prospective study was to assess the prognostic value of the early neonatal EEG in the full term infant, with emphasis on the evaluation of the additional value of serial EEGs doi: 10.1053/ejpn.2001.0496 available online at http://www.idealibrary.com on European Journal of Paediatric Neurology 2001; 5: 155±160 1090±3798/01/05/0155+6 $35.00 & 2001 European Paediatric Neurology Society Received 19.01.2001. Revised 01.05.2001. Accepted 05.05.2001. Correspondence: Dr E Zeinstra, Department of Neurology, University Hospital Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands e-mail: e.m.p.e.zeinstra@neuro.azg.nl