Lavery Shelly, Shah Divyen K, Hunt Rodney W, Filan Peter M, Doyle Lex W, Inder Terrie E
Victorian Infant Brain Study Group, and Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Victoria, AUstralia.
J Paediatr Child Health. 2008 May;44(5):285-90. doi: 10.1111/j.1440-1754.2007.01270.x.
The demand for early diagnosis and prognostication of cerebral injury in the encephalopathic term infant is increasing to facilitate appropriate management. The single-channel amplitude-integrated electroencephalogram (S-aEEG) has been shown to have predictive utility for the severely encephalopathic infant. New bedside aEEG devices with more channels are entering the neonatal environment. Little data are available to compare the utility of two channels (B-aEEG) with that of an S-aEEG recording.
To compare the utility of the S-aEEG and the B-aEEG in the prediction of cerebral injury, as determined by magnetic resonance imaging (MRI), and neurodevelopmental outcome in the term encephalopathic infant.
Term encephalopathic infants, with or without seizures, admitted to a level III NICU were included in this study. These infants had simultaneous S-aEEG and B-aEEG recordings. MRI was undertaken during the clinical course and classified as to the extent of cerebral injury. Neurological outcome was assessed at 2 years of age.
Twenty-eight encephalopathic term infants were included in the study. There was high level of agreement between both brain monitors (Kappa = 0.68, P < 0.001), but there was disagreement in the classification in four cases where the S-aEEG was normal when the B-aEEG was severely abnormal (McNemar's test P = 0.046). Of note in these four cases, all had a severely abnormal MRI and poor neurodevelopmental outcome at 2 years.
Amplitude measurements by the B-aEEG appear more sensitive in detecting cerebral injury in comparison with the S-aEEG, particularly in the setting of unilateral injury.
为便于进行适当管理，对脑病足月婴儿脑损伤的早期诊断和预后评估的需求日益增加。单通道振幅整合脑电图（S-aEEG）已被证明对重症脑病婴儿具有预测价值。新型多通道床边aEEG设备正在进入新生儿病房。目前几乎没有数据可用于比较两通道（B-aEEG）与S-aEEG记录的效用。
比较S-aEEG和B-aEEG在预测脑病足月婴儿脑损伤（由磁共振成像（MRI）确定）及神经发育结局方面的效用。
本研究纳入入住三级新生儿重症监护病房（NICU）的有或无癫痫发作的脑病足月婴儿。这些婴儿同时进行了S-aEEG和B-aEEG记录。在临床过程中进行MRI检查，并对脑损伤程度进行分类。在2岁时评估神经学结局。
28例脑病足月婴儿纳入研究。两种脑电监测仪之间的一致性较高（Kappa = 0.68，P < 0.001），但在4例中存在分类不一致的情况，即B-aEEG严重异常而S-aEEG正常（McNemar检验P = 0.046）。值得注意的是，在这4例中，所有婴儿的MRI均严重异常，且2岁时神经发育结局较差。
与S-aEEG相比，B-aEEG的振幅测量在检测脑损伤方面似乎更敏感，尤其是在单侧损伤的情况下。
