Mulkey Sarah B, Yap Vivien L, Bai Shasha, Ramakrishnaiah Raghu H, Glasier Charles M, Bornemeier Renee A, Schmitz Michael L, Bhutta Adnan T
Department of Pediatrics, Section of Pediatric Neurology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
Department of Pediatrics, Section of Neonatology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
Pediatr Neurol. 2015 Jun;52(6):599-605. doi: 10.1016/j.pediatrneurol.2015.02.026. Epub 2015 Mar 5.
The study aims are to evaluate cerebral background patterns using amplitude-integrated electroencephalography in newborns with critical congenital heart disease, determine if amplitude-integrated electroencephalography is predictive of preoperative brain injury, and assess the incidence of preoperative seizures. We hypothesize that amplitude-integrated electroencephalography will show abnormal background patterns in the early preoperative period in infants with congenital heart disease that have preoperative brain injury on magnetic resonance imaging.
Twenty-four newborns with congenital heart disease requiring surgery at younger than 30 days of age were prospectively enrolled within the first 3 days of age at a tertiary care pediatric hospital. Infants had amplitude-integrated electroencephalography for 24 hours beginning close to birth and preoperative brain magnetic resonance imaging. The amplitude-integrated electroencephalographies were read to determine if the background pattern was normal, mildly abnormal, or severely abnormal. The presence of seizures and sleep-wake cycling were noted. The preoperative brain magnetic resonance imaging scans were used for brain injury and brain atrophy assessment.
Fifteen of 24 infants had abnormal amplitude-integrated electroencephalography at 0.71 (0-2) (mean [range]) days of age. In five infants, the background pattern was severely abnormal. (burst suppression and/or continuous low voltage). Of the 15 infants with abnormal amplitude-integrated electroencephalography, 9 (60%) had brain injury. One infant with brain injury had a seizure on amplitude-integrated electroencephalography. A severely abnormal background pattern on amplitude-integrated electroencephalography was associated with brain atrophy (P = 0.03) and absent sleep-wake cycling (P = 0.022).
Background cerebral activity is abnormal on amplitude-integrated electroencephalography following birth in newborns with congenital heart disease who have findings of brain injury and/or brain atrophy on preoperative brain magnetic resonance imaging.
本研究旨在利用振幅整合脑电图评估患有严重先天性心脏病的新生儿的脑背景模式，确定振幅整合脑电图是否可预测术前脑损伤，并评估术前癫痫发作的发生率。我们假设，对于先天性心脏病患儿，若其在术前磁共振成像显示有脑损伤，则在术前早期，振幅整合脑电图会显示异常的背景模式。
24例年龄小于30天需要手术的先天性心脏病新生儿在一家三级儿科医院出生后的前3天内被前瞻性纳入研究。婴儿在接近出生时开始进行24小时的振幅整合脑电图检查以及术前脑磁共振成像检查。读取振幅整合脑电图结果以确定背景模式是正常、轻度异常还是严重异常。记录癫痫发作和睡眠-觉醒周期的情况。术前脑磁共振成像扫描用于评估脑损伤和脑萎缩情况。
24例婴儿中有15例在0.71（0 - 2）（均值[范围]）日龄时振幅整合脑电图异常。5例婴儿的背景模式严重异常（爆发抑制和/或持续低电压）。在15例振幅整合脑电图异常的婴儿中，9例（60%）有脑损伤。1例有脑损伤的婴儿在振幅整合脑电图检查时有癫痫发作。振幅整合脑电图上严重异常的背景模式与脑萎缩（P = 0.03）和睡眠-觉醒周期缺失（P = 0.022）相关。
对于术前脑磁共振成像显示有脑损伤和/或脑萎缩的先天性心脏病新生儿，出生后其振幅整合脑电图的脑背景活动异常。
