Leroy-Terquem Elise, Vermersch Anne Isabelle, Dean Pauline, Assaf Ziad, Boddaert Nathalie, Lapillonne Alexandre, Magny Jean-François
Department of Neonatology, Necker-Enfants Malades Hospital, Paris, France.
Neonatology. 2017;112(4):359-364. doi: 10.1159/000478964. Epub 2017 Aug 11.
Abnormal interhemispheric synchrony has been described in many clinical compromises in brain function, but its prognostic value in neonatal hypoxic-ischemic encephalopathy (HIE) is unknown.
The study aimed at describing the frequency of abnormal interhemispheric synchrony in infants with HIE and to explore its prognostic value. The main outcome was survival without major disabilities.
We performed a single-center retrospective cohort study and enrolled 40 neonates with HIE who underwent hypothermia.
Abnormal interhemispheric synchrony was observed in 23% of the patients with HIE. Sensitivity and specificity values for predicting survival without major disabilities were 90 and 67% for seizures, 50 and 97% for status epilepticus, 60 and 97% for highly abnormal EEG in the first 48 h, and 80 and 97% for EEG asynchrony, respectively. The prognostic value of asynchrony improved to 100% sensitivity, whereas specificity remained unchanged, when associated with highly abnormal EEG within the first 48 h of life.
Abnormal interhemispheric synchrony was observed in a quarter of the patients with HIE. This pilot study suggests that the prognostic value of asynchrony is excellent, especially when combined with EEG background analysis.
大脑半球间同步异常已在多种脑功能临床损害中被描述，但其在新生儿缺氧缺血性脑病（HIE）中的预后价值尚不清楚。
本研究旨在描述HIE患儿大脑半球间同步异常的发生率，并探讨其预后价值。主要结局为存活且无严重残疾。
我们进行了一项单中心回顾性队列研究，纳入40例接受低温治疗的HIE新生儿。
23%的HIE患儿观察到大脑半球间同步异常。预测存活且无严重残疾的敏感性和特异性值分别为：癫痫发作时为90%和67%，癫痫持续状态时为50%和97%，出生后48小时内脑电图高度异常时为60%和97%，脑电图不同步时为80%和97%。当与出生后48小时内脑电图高度异常相关时，不同步的预后价值敏感性提高到100%，而特异性保持不变。
四分之一的HIE患儿观察到大脑半球间同步异常。这项初步研究表明，不同步的预后价值极佳，尤其是与脑电图背景分析相结合时。
