Merchant Nazakat, Azzopardi Denis
Centre for the Developing Brain, Department of Perinatal Imaging, King's College London, St Thomas' Hospital, London, UK; Department of Neonatology and Paediatrics, West Hertfordshire NHS Trust, London, UK.
Dev Med Child Neurol. 2015 Apr;57 Suppl 3:8-16. doi: 10.1111/dmcn.12726.
Hypoxic-ischaemic encephalopathy (HIE) is a leading cause of acquired neonatal brain injury. Assessment of the severity of cerebral injury and likely neurological outcome in infants with HIE is important for determining management and prognosis, for counselling parents, and for selection for neuroprotective trials. The condition of the infant at birth, the severity of HIE, neurophysiological tests, including amplitude-integrated electroencephalography (aEEG), biochemical markers, and neuroimaging have been used to assess prognosis and predict long-term outcome. The predictive accuracy of these indicators in the early postnatal period is modest. Neurophysiological assessment seems to be most helpful during the first 24 to 48 hours after birth whilst magnetic resonance imaging (MRI) seems most informative later. Several biochemical markers, including serum S100β and neuron-specific enolase (NSE), are also associated with HIE but their levels depend on the timing of sampling and their prognostic value is uncertain. Comprehensive neurophysiological assessment and neuroimaging may be limited to specialist centres. Therapeutic hypothermia is now standard care in infants with moderate to severe HIE so it is important to examine the influence of hypothermia on the assessment of prognosis in these infants.
缺氧缺血性脑病（HIE）是新生儿获得性脑损伤的主要原因。评估HIE婴儿的脑损伤严重程度及可能的神经学预后，对于确定治疗方案和预后、为家长提供咨询以及选择进行神经保护试验都很重要。出生时婴儿的状况、HIE的严重程度、神经生理学检查（包括振幅整合脑电图（aEEG））、生化标志物和神经影像学检查都已被用于评估预后和预测长期结局。这些指标在出生后早期的预测准确性一般。神经生理学评估在出生后的头24至48小时似乎最有帮助，而磁共振成像（MRI）在后期似乎提供的信息最多。包括血清S100β和神经元特异性烯醇化酶（NSE）在内的几种生化标志物也与HIE有关，但其水平取决于采样时间，且其预后价值尚不确定。全面的神经生理学评估和神经影像学检查可能仅限于专科中心。治疗性低温现在是中度至重度HIE婴儿的标准治疗方法，因此研究低温对这些婴儿预后评估的影响很重要。
