Benavente-Fernández Isabel, Lubián-López Simón P, Zafra-Rodríguez Pamela, Alonso-Ojembarrena Almudena, Segado-Arenas Antonio, Lechuga-Sancho Alfonso M
*Department of Neonatology, "Puerta del Mar" University Hospital, Cadiz, Spain;†Nene Foundation Neonatology, Madrid, Spain; and‡Department of Pediatric, "Puerta del Mar" University Hospital, Cadiz, Spain.
J Clin Neurophysiol. 2017 Sep;34(5):456-460. doi: 10.1097/WNP.0000000000000399.
Preterm small-for-gestational-age (SGA) infants are at risk for a high mortality rate and impaired cognitive development. Only a few studies have focused on amplitude-integrated EEG (aEEG) in preterm SGA infants. They have been shown to have a slower rate of brain maturation, but these findings have not consistently been related to neurodevelopmental outcomes. The aim of our study was to evaluate early aEEG monitoring in SGA compared with adequate-for-gestational-age preterms.
This prospective cohort study enrolled infants with very low birth weight who were admitted to the neonatal intensive care unit at Hospital Puerta del Mar, Cádiz, Spain, from June 2009 to September 2012. This study was a subanalysis of SGA from the global cohort previously described by our group. Adverse outcome included severe intraventricular hemorrhage and/or death. Cerebral function was monitored using aEEG recordings during the first 72 hours of life.
Preterm SGA infants (18 SGA in the global cohort of 92 patients) had lower 1- and 5-minute Apgar scores, higher score for neonatal acute physiology perinatal extension II scores, and higher proportion of adverse outcomes. When comparing preterm adequate-for-gestational-age infants with SGA infants with good prognosis, those with SGA had more mature and continuous aEEG patterns. Low margin amplitude depression was not as severe in these patients, and a higher proportion of these patients developed sleep-wake cycles.
The results of our study suggest that SGA infants with a good prognosis have a more mature aEEG pattern than preterm adequate-for-gestational-age patients with the same outcome. These findings support the brain sparing theory in SGA infants.
早产小于胎龄儿（SGA）有高死亡率和认知发育受损的风险。仅有少数研究关注早产SGA婴儿的振幅整合脑电图（aEEG）。已表明他们的大脑成熟速率较慢，但这些发现并未始终与神经发育结局相关。我们研究的目的是评估与适于胎龄的早产儿相比，SGA婴儿的早期aEEG监测情况。
这项前瞻性队列研究纳入了2009年6月至2012年9月在西班牙加的斯市马尔港医院新生儿重症监护病房住院的极低出生体重儿。本研究是对我们小组先前描述的全球队列中SGA的亚分析。不良结局包括严重脑室内出血和/或死亡。在出生后的头72小时内使用aEEG记录监测脑功能。
早产SGA婴儿（全球92例患者队列中有18例SGA）1分钟和5分钟阿氏评分较低，新生儿急性生理学围产期延长II评分较高，不良结局比例较高。将适于胎龄的早产儿与预后良好的SGA婴儿进行比较时，SGA婴儿的aEEG模式更成熟且更持续。这些患者的低边缘振幅降低不那么严重，并且这些患者中出现睡眠-觉醒周期的比例更高。
我们的研究结果表明，预后良好的SGA婴儿比具有相同结局的适于胎龄早产儿具有更成熟的aEEG模式。这些发现支持了SGA婴儿的脑保护理论。
