Chequer R S, Tharp B R, Dreimane D, Hahn J S, Clancy R R, Coen R W
Division of Pediatric Neurology, Stanford University Medical Center, California.
Pediatr Neurol. 1992 Nov-Dec;8(6):417-22. doi: 10.1016/0887-8994(92)90001-f.
Neonatal meningitis is associated with significant neurologic sequelae. Previous studies from our laboratory and others demonstrated electroencephalography (EEG) to be a useful tool in predicting long-term neurologic outcome in at-risk neonates. We, therefore, retrospectively studied 29 infants with culture-proved neonatal meningitis who died in the neonatal period or survived to follow-up at a mean of 34.4 months. Seventy-five EEGs were obtained during the acute phase of infection; the degree of EEG background abnormality proved to be an accurate predictor of outcome. Infants who had normal or mildly abnormal backgrounds had normal outcomes, whereas those with markedly abnormal EEGs died or manifested severe neurologic sequelae at follow-up. When the EEG was considered with the presence or absence of seizures and the level of consciousness, an accurate prediction of neurologic outcome was obtained in 27 infants (93%). Although the EEG patterns were generally nonspecific, some abnormalities, such as positive rolandic sharp waves, persistent hemispheric or focal voltage attenuation, suggested more specific pathology (i.e., deep white matter necrosis, large-vessel infarction and abscess, respectively). EEG was also valuable for the recognition of subtle and subclinical seizures. Therefore, we conclude that EEG is a valuable tool for predicting the long-term prognoses of infants with neonatal meningitis.
新生儿脑膜炎与显著的神经后遗症相关。我们实验室及其他机构之前的研究表明，脑电图（EEG）是预测高危新生儿长期神经预后的有用工具。因此，我们对29例经培养证实患有新生儿脑膜炎的婴儿进行了回顾性研究，这些婴儿在新生儿期死亡或存活至平均34.4个月时接受随访。在感染急性期共获得75份脑电图；脑电图背景异常程度被证明是预后的准确预测指标。背景正常或轻度异常的婴儿预后正常，而脑电图明显异常的婴儿在随访时死亡或出现严重神经后遗症。当结合癫痫发作情况及意识水平考虑脑电图时，27例婴儿（93%）的神经预后得到了准确预测。虽然脑电图模式通常是非特异性的，但一些异常，如罗兰区阳性尖波、持续性半球或局灶性电压衰减，分别提示了更具特异性的病理改变（即深部白质坏死、大血管梗死和脓肿）。脑电图对于识别细微和亚临床癫痫发作也很有价值。因此，我们得出结论，脑电图是预测新生儿脑膜炎婴儿长期预后的有价值工具。
