Skranes Janne Helen, Løhaugen Gro, Schumacher Eva Margrethe, Osredkar Damjan, Server Andres, Cowan Frances Mary, Stiris Tom, Fugelseth Drude, Thoresen Marianne
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neonatal Intensive Care, Oslo University Hospital, Ullevål, Oslo, Norway.
Department of Pediatric, Sørlandet Hospital, Arendal, Norway.
J Pediatr. 2017 Aug;187:34-42. doi: 10.1016/j.jpeds.2017.04.041. Epub 2017 May 23.
To examine whether using an amplitude-integrated electroencephalography (aEEG) severity pattern as an entry criterion for therapeutic hypothermia better selects infants with hypoxic-ischemic encephalopathy and to assess the time-to-normal trace for aEEG and magnetic resonance imaging (MRI) lesion load as 24-month outcome predictors.
Forty-seven infants meeting Norwegian therapeutic hypothermia guidelines were enrolled prospectively. Eight-channel EEG/aEEG was recorded from 6 hours until after rewarming, and read after discharge. Neonatal MRI brain scans were scored for summated (range 0-11) regional lesion load. A poor outcome at 2 years was defined as death or a Bayley Scales of Infant-Toddler Development cognitive or motor composite score of <85 or severe hearing or visual loss.
Three severity groups were defined from the initial aEEG; continuous normal voltage (CNV; n = 15), discontinuous normal voltage (DNV; n = 18), and a severe aEEG voltage pattern (SEVP; n = 14). Any seizure occurrence was 7% CNV, 50% DNV, and 100% SEVP. Infants with SEVP with poor vs good outcome had a significantly longer median (IQR) time-to-normal trace: 58 hours (9-79) vs 18 hours (12-19) and higher MRI lesion load: 10 (3-10) vs 2 (1-5). A poor outcome was noted in 3 of 15 infants with CNV, 4 of 18 infants with DNV, and 8 of 14 infants with SEVP. Using multiple stepwise linear regression analyses including only infants with abnormal aEEG (DNV and SEVP), MRI lesion load significantly predicted cognitive and motor scores. For the SEVP group alone, time-to-normal trace was a stronger outcome predictor than MRI score. No variable predicted outcome in infants with CNV.
Selection of infants with encephalopathy for therapeutic hypothermia after perinatal asphyxia may be improved by including only infants with an early moderate or severely depressed background aEEG trace.
探讨将振幅整合脑电图（aEEG）严重程度模式作为治疗性低温的纳入标准是否能更好地筛选出缺氧缺血性脑病婴儿，并评估aEEG恢复正常轨迹的时间以及磁共振成像（MRI）病变负荷作为24个月预后预测指标的情况。
前瞻性纳入47名符合挪威治疗性低温指南的婴儿。从6小时开始记录八通道脑电图/aEEG直至复温后，并在出院后进行解读。对新生儿脑部MRI扫描进行评分以计算区域病变负荷总和（范围为0 - 11）。2岁时不良预后定义为死亡或贝利婴幼儿发育量表认知或运动综合评分<85或严重听力或视力丧失。
根据初始aEEG定义了三个严重程度组；持续正常电压（CNV；n = 15）、间断正常电压（DNV；n = 18）和严重aEEG电压模式（SEVP；n = 14）。任何癫痫发作发生率在CNV组为7%，DNV组为50%，SEVP组为100%。SEVP组中预后不良与预后良好的婴儿相比，恢复正常轨迹的中位（四分位间距）时间显著更长：58小时（9 - 79）对18小时（12 - 19），且MRI病变负荷更高：10（3 - 10）对2（1 - 5）。15名CNV婴儿中有3名、18名DNV婴儿中有4名、14名SEVP婴儿中有8名预后不良。使用仅包括aEEG异常（DNV和SEVP）婴儿的多元逐步线性回归分析，MRI病变负荷显著预测认知和运动评分。仅对于SEVP组，恢复正常轨迹的时间比MRI评分是更强的预后预测指标。CNV婴儿中没有变量能预测预后。
围产期窒息后选择脑病婴儿进行治疗性低温时，仅纳入早期背景aEEG轨迹为中度或重度抑制的婴儿可能会改善选择效果。
