Maayke Hunfeld

30 Chapter 2 Neuromonitoring methods included neurological examination, routine EEG and continuous EEG (cEEG), transcranial Doppler (TCD), MRI, head CT, plasma biomarkers, somatosensory evoked potential (SEP) and brainstem auditory evoked potential (BAEP), and one included repeated routine EEG as well as SEP and BAEP (table 1). All evidence was graded 2B-2C. Details on study type and population as well as outcome scores and definitions are specified in Supplemental Table 2-6 (Supplemental Digital Content 2, http://links.lww.com/PCC/B352) . Neuromonitoring method Number of articles Neurological examination 6 Electroencephalography (EEG) 10 Transcranial doppler 1 Neuro imaging 7 Plasma biomarkers 4 Evoked potentials 2 Table 1. Article categories (n=27, 3 articles are listed twice, as they described more neuromonitoring modalities (Neurological examination, EEG monitoring and Evoked Potentials) Neuromonitoring methods Neurological examination Six studies were included in our review (Supplemental Table 2, Supplemental Digital Content 2, http://links.lww.com/ PCC/B352). Three were prospective and three retrospective. In a prospective cohort including 44 children with hypoxic ischaemic encephalopathy (HIE) and impaired consciousness, a Glasgow Coma Scale of less than 5, absence of pupillary responses or lack of spontaneous respiratory activity at 24 hours from admission had a positive predictive value (PPV) of 100% for poor outcome in the third year after event (13). In another prospective cohort of 36 children with HIE the sensitivity and specificity for absent motor responses during the first 9 days for a poor outcome at 5 years were 93% and 50% respectively. This was 47% and 100% for the absence of pupillary responses (14). Abend et al showed that absent motor and pupillary responses after normothermia in children post CA and therapeutic hypothermia (TH) are highly predictive for a poor outcome at PICU discharge (n=35, PPV 100%)(15). Brooks et al evaluated motor responses, pupillary responses and brainstem reflexes in 41 children after CA and found that all patients with the absence of one of these responses had a poor outcome (p<0.001), the majority within 12 hours post-ROSC (16).