Ancora Gina, Soffritti Silvia, Lodi Raffaele, Tonon Caterina, Grandi Sara, Locatelli Chiara, Nardi Laura, Bisacchi Nicoletta, Testa Claudia, Tani Giovanni, Ambrosetto Paolo, Faldella Giacomo
Neonatology Unit, Department of Woman, Child and Adolescent Health, University of Bologna, Italy.
Brain Dev. 2010 Nov;32(10):835-42. doi: 10.1016/j.braindev.2009.11.008. Epub 2010 Jan 8.
Brain damage following a perinatal hypoxic-ischemic (HI) insult has been documented by different diagnostic techniques. The aim of the present study was to relate a-EEG time course during the first 24h of life to brain metabolic changes detected by proton MR spectroscopy ((1)H-MRS) at 7-10days of life and to evaluate their correlation with outcome.
Thirty-two patients with any grade HI encephalopathy were studied. Thirty-one out of 32 patients survived and underwent (1)H-MRS examination at 7-10days of life; a-EEG was recorded during the first 24h of life in 27/32 newborns; 26 patients underwent both examinations. Griffiths test, evaluation of motor skills, visual and hearing function were performed at regular intervals until the age of 2years.
a-EEG at 6, 12 and 24h of life showed a significant correlation with outcome. N-acetyl-aspartate/creatine (Cr), Lactate/Cr and myo-inositol differed significantly between patients with normal or poor outcome. a-EEG time course during the first 24h of life showed improvement in newborns with normal (1)H-MRS and good outcome and a deterioration in those with abnormal (1)H-MRS and poor outcome.
a-EEG time course may be able to document the severity and the evolution of the cerebral damage following an HI event. a-EEG is related to the severity of cerebral injury as defined by (1)H-MRS and both examinations showed a good correlation with outcome. These data, obtained in non-cooled infants, may represent reference data for future investigations in cooled infants.
围产期缺氧缺血性（HI）损伤后的脑损伤已通过不同的诊断技术得到证实。本研究的目的是将出生后24小时内的振幅整合脑电图（a-EEG）时间进程与出生7 - 10天时通过质子磁共振波谱（（1）H-MRS）检测到的脑代谢变化相关联，并评估它们与预后的相关性。
对32例任何级别的HI脑病患者进行了研究。32例患者中有31例存活，并在出生7 - 10天时接受了（1）H-MRS检查；27/32例新生儿在出生后24小时内记录了a-EEG；26例患者接受了两项检查。定期进行格里菲斯测试、运动技能、视觉和听力功能评估，直至2岁。
出生后6、12和24小时的a-EEG与预后显著相关。正常或预后不良的患者之间，N-乙酰天门冬氨酸/肌酸（Cr）、乳酸/Cr和肌醇有显著差异。出生后24小时内的a-EEG时间进程显示，（1）H-MRS正常且预后良好的新生儿有所改善，而（1）H-MRS异常且预后不良的新生儿则有所恶化。
a-EEG时间进程可能能够记录HI事件后脑损伤的严重程度和演变。a-EEG与（1）H-MRS所定义的脑损伤严重程度相关，两项检查均与预后有良好的相关性。这些在未进行低温治疗的婴儿中获得的数据，可能代表未来对低温治疗婴儿进行研究的参考数据。
