Shalak Lina F, Laptook Abbot R, Velaphi Sithembiso C, Perlman Jeffrey M
Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9063, USA.
Pediatrics. 2003 Feb;111(2):351-7. doi: 10.1542/peds.111.2.351.
The objectives of this study were to determine, first, whether an early neurologic examination could predict a persistent abnormal neonatal neurologic state comparable to the amplitude-integrated electroencephalography (a-EEG) and, second, whether a combination of the 2 methods would further enhance early identification of high-risk infants.
Fifty term infants were enrolled prospectively when they had evidence of intrapartum distress, Apgar score <or=5 at 5 minutes, or cord arterial pH <or=7.00 and were admitted to intensive care. Each enrolled infant underwent an early neurologic examination using a modified Sarnat staging system (stages 2 and 3 were regarded as abnormal) and a blinded simultaneous a-EEG measurement. Predictive values were calculated for a short-term abnormal outcome defined as persistent moderate to severe encephalopathy beyond 5 days.
An abnormal short-term outcome was present in 14 (28%) of 50 infants. The neurologic examination was performed at 5 +/- 3 hours after delivery. A short-term abnormal outcome occurred in 9 (53%) of 17 infants with initial stage 2 and in both infants with initial stage 3 encephalopathy. In addition, 13 infants manifested features of both stage 1s and 2 and post hoc were classified (S1-2). Three of the latter infants (23%) developed an abnormal short-term outcome. The a-EEG was abnormal in 15 (30%) infants, 11 (73%) of whom developed an abnormal outcome. An abnormal a-EEG was more specific (89% vs 78%), had a greater positive predictive value (73% vs 58%), and had similar sensitivity (79% vs 78%) and negative predictive value (90% vs 91%) when compared with an abnormal early neurologic examination. A combination of abnormalities had the highest specificity (94%) and positive predictive value (85%).
The combination of the a-EEG and the neurologic examination shortly after birth enhances the ability to identify high-risk infants and limits the number of infants who would be falsely identified compared with either evaluation alone.
本研究的目的，其一，是确定早期神经系统检查是否能够预测与振幅整合脑电图（a-EEG）相当的持续性异常新生儿神经状态；其二，是确定这两种方法的联合使用是否会进一步提高高危婴儿的早期识别率。
前瞻性纳入50名足月儿，这些婴儿有产时窘迫证据、5分钟时阿氏评分≤5分或脐动脉pH≤7.00，并被收入重症监护病房。每名纳入的婴儿均接受使用改良Sarnat分期系统的早期神经系统检查（2期和3期被视为异常），并同时进行盲法a-EEG测量。计算针对定义为5天后持续存在中度至重度脑病的短期异常结局的预测值。
50名婴儿中有14名（28%）出现短期异常结局。神经系统检查在出生后5±3小时进行。17名初始为2期的婴儿中有9名（53%）以及2名初始为3期脑病的婴儿出现短期异常结局。此外，13名婴儿表现出1期和2期的特征，事后被归类为（S1-2）。后一组婴儿中有3名（23%）出现短期异常结局。15名（30%）婴儿的a-EEG异常，其中11名（73%）出现异常结局。与异常早期神经系统检查相比，异常a-EEG更具特异性（89%对78%），阳性预测值更高（73%对58%），敏感性（79%对78%）和阴性预测值（90%对91%）相似。异常情况的联合具有最高的特异性（94%）和阳性预测值（85%）。
出生后不久a-EEG与神经系统检查的联合使用提高了识别高危婴儿的能力，并与单独的任何一种评估相比，限制了被错误识别的婴儿数量。
