Department of Neonatology, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, The Netherlands.
Pediatr Res. 2013 Aug;74(2):180-5. doi: 10.1038/pr.2013.84. Epub 2013 May 31.
Hypothermia is an established therapy in term neonates to reduce death and disability after perinatal asphyxia. Near-infrared spectroscopy-monitored regional cerebral oxygen saturation (rScO2) and amplitude-integrated electroencephalogram (aEEG)-monitored background pattern have been shown to be early predictors of long-term neurodevelopmental outcome. The aim of this study was to investigate the prognostic value of rScO2 and aEEG for neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy (HIE) treated with hypothermia.
In neonates with HIE who were subjected to hypothermia, the aEEG background pattern and rScO2 were studied prospectively from admission up to 84 h in relation to early magnetic resonance imaging and neurodevelopmental outcome at 18 mo of age.
Of 39 infants, 12 neonates died because of neurological deterioration. One had an adverse outcome and 26 had a favorable outcome. The rScO2 was higher in neonates with adverse outcome, although aEEG scores were lower. Positive predictive values at 12, 24, and 36 h of age for adverse outcome ranged from 50 to 67% for rScO2 and aEEG; negative predictive values ranged from 73 to 96% for rScO2 and 90 to 100% for aEEG. Combining rScO2 and aEEG increased positive predictive values (70-91%) and negative predictive values (90-100%).
During hypothermia, rScO2 and aEEG measurements are early predictors of long-term outcome after HIE. Combining both parameters further improves early prediction.
低温疗法是一种成熟的治疗方法，可用于治疗围产期窒息后的足月新生儿，以降低死亡率和残疾率。近红外光谱监测局部脑氧饱和度(rScO2)和振幅整合脑电图(aEEG)监测背景模式已被证明是长期神经发育结局的早期预测指标。本研究旨在探讨 rScO2 和 aEEG 在接受低温治疗的缺氧缺血性脑病(HIE)新生儿中的预后价值。
在接受低温治疗的 HIE 新生儿中，前瞻性研究了入院后至 84 小时的 aEEG 背景模式和 rScO2，与早期磁共振成像和 18 个月时的神经发育结局相关。
在 39 例婴儿中，有 12 例因神经恶化而死亡。1 例预后不良，26 例预后良好。尽管 aEEG 评分较低，但预后不良的新生儿 rScO2 较高。rScO2 和 aEEG 在 12、24 和 36 小时时对不良预后的阳性预测值分别为 50%至 67%和 73%至 96%；阴性预测值分别为 rScO2 的 90%至 100%和 aEEG 的 90%至 100%。联合 rScO2 和 aEEG 可提高阳性预测值(70%-91%)和阴性预测值(90%-100%)。
在低温治疗期间，rScO2 和 aEEG 测量是 HIE 后长期结局的早期预测指标。联合这两个参数可进一步提高早期预测能力。
