Department of Pediatrics, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10021, USA.
J Pediatr. 2011 Aug;159(2):232-7. doi: 10.1016/j.jpeds.2011.01.006. Epub 2011 Feb 25.
To determine whether hypothermia modulates acquisition of sleep-wake cycling in term neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE) and the relationship to outcome.
Twenty-nine term infants with moderate to severe HIE treated with selective head cooling were evaluated. All were monitored with amplitude-integrated electroencephalography during and video electroencephalography immediately after hypothermia for ≥72 hours. Electroencephalograpic data were analyzed for background and sleep-wake cycling. Abnormal outcome included death or severe global neurodevelopmental disability ≥18 months.
Acquisition of sleep-wake cycling was noted in nine infants by 72 hours, in 13 by 96 hours, 19 by 120 hours, and 22 by 144 hours. Presence of sleep-wake cycling was associated with normal outcome, that is, 14 of 22 (64%), versus abnormal outcome, that is, none of seven without sleep-wake cycling (P = .006). The presence of sleep-wake cycling by 120 hours had a positive predictive value of 68% and negative predictive value of 90%. Magnetic resonance imaging abnormalities were related to onset of sleep-wake cycling.
Although onset of sleep-wake cycling is markedly delayed in term neonates with moderate to severe HIE treated with hypothermia, approximately 65% with acquisition of cycling have a normal outcome. Sleep-wake cycling is an important additional tool for assessing recovery in term infants with moderate to severe HIE treated with hypothermia.
确定体温过低是否调节中重度缺氧缺血性脑病（HIE）足月新生儿睡眠-觉醒周期的获得，以及与预后的关系。
对 29 例接受选择性头部冷却治疗的中重度 HIE 足月婴儿进行评估。所有婴儿均在接受亚低温治疗期间进行振幅整合脑电图监测，并在亚低温治疗≥72 小时后立即进行视频脑电图监测。对脑电图数据进行背景和睡眠-觉醒周期分析。异常结局包括死亡或≥18 个月的严重全脑发育障碍。
9 例婴儿在 72 小时内出现睡眠-觉醒周期，13 例在 96 小时内，19 例在 120 小时内，22 例在 144 小时内。存在睡眠-觉醒周期与正常结局相关，即 22 例中有 14 例（64%），而异常结局中，7 例中无一例存在睡眠-觉醒周期（P=0.006）。120 小时内出现睡眠-觉醒周期的阳性预测值为 68%，阴性预测值为 90%。磁共振成像异常与睡眠-觉醒周期的开始有关。
尽管接受亚低温治疗的中重度 HIE 足月新生儿睡眠-觉醒周期的起始明显延迟，但约 65%的患儿在获得周期后具有正常结局。睡眠-觉醒周期是评估中重度 HIE 接受亚低温治疗的足月婴儿恢复情况的重要补充工具。
