Unité de Neurophysiologie Clinique, Hôpital Yves Le Foll, Saint Brieuc, France.
Arch Dis Child Fetal Neonatal Ed. 2012 Mar;97(2):F106-9. doi: 10.1136/adc.2010.204735. Epub 2011 Jun 9.
To evaluate the prognostic value of EEG regarding the psychomotor outcomes of very premature newborns.
76 premature infants <30 weeks gestation were enrolled between January 2001 and August 2004. They were examined at 4 and 9 months corrected ages, and at 18 months, 3-4 years and 5-6 years. EEGs performed in the neonatal period were analysed by two neurologists blind to the child's outcome.
The mean follow-up was 5.6 years. 25 infants had normal neurological development and all EEGs were normal for 22 of these. 36 others had developmental disabilities (7 motor sequelae and 29 delayed psychomotor development). Of 187 EEGs, 43 were dysmature, 13 disorganised, 2 displayed electrical seizures without clinical manifestations and 15 showed other abnormal features. Dysmaturity was the predominant EEG pattern in newborns with severe or moderate sequelae and was persistent on several EEGs in 12 of these. In contrast, only three infants with normal development had a dysmature pattern on one EEG. All infants with a disorganised pattern had cognitive sequelae, and two had cerebral palsy. The sensitivity of EEG regarding psychomotor outcome was 83.3%, the specificity was 88% and the positive predictive value was 90.9%.
Very preterm neonates remain at high risk of neurological sequelae and EEG is a sensitive method for assessing neuromotor and cognitive prognosis. A dysmature pattern was the predominant EEG characteristic in infants who developed severe or moderate impairment. Early postnatal tracing is useful but additional recordings are generally necessary to detect high-risk newborns.
评估脑电图对极早产儿精神运动结局的预后价值。
2001 年 1 月至 2004 年 8 月期间共纳入 76 例胎龄<30 周的早产儿。他们在 4 个月和 9 个月校正年龄时、18 个月、3-4 岁和 5-6 岁时进行检查。由两位对患儿结局不知情的神经科医生对新生儿期进行的脑电图进行分析。
平均随访时间为 5.6 年。25 例婴儿有正常的神经发育，其中 22 例脑电图均正常。其余 36 例有发育障碍（7 例有运动后遗症，29 例有精神运动发育迟缓）。187 次脑电图中，43 次不成熟，13 次无组织，2 次显示无临床表现的电癫痫发作，15 次显示其他异常特征。在有严重或中度后遗症的新生儿中，不成熟模式是主要的脑电图模式，其中 12 例在几个脑电图上持续存在。相比之下，只有 3 例发育正常的婴儿在一次脑电图上出现不成熟模式。所有有不规律模式的婴儿都有认知后遗症，其中 2 例有脑瘫。脑电图对精神运动结局的敏感性为 83.3%，特异性为 88%，阳性预测值为 90.9%。
极早产儿仍有发生神经后遗症的高风险，脑电图是评估神经运动和认知预后的敏感方法。不成熟模式是发生严重或中度损害的婴儿的主要脑电图特征。早期的产后追踪是有用的，但通常需要额外的记录来发现高危新生儿。
