Departments of Pediatrics, Ain Shams University, Cairo, Egypt.
Radiodiagnosis, Ain Shams University, Cairo, Egypt.
Pediatr Res. 2018 Aug;84(2):261-266. doi: 10.1038/s41390-018-0062-4. Epub 2018 May 26.
Sepsis leads to systemic inflammatory response with cerebral blood flow (CBF) alteration and blood-brain barrier disruption that contribute to sepsis-associated encephalopathy (SAE). We aimed to evaluate cord blood neuron-specific enolase (cNSE) and CBF in early-onset neonatal sepsis (EONS) as predictors of SAE and to define short-term neurodevelopmental outcomes among survivors.
cNSE was measured in 200 neonates with antenatal risk factors for EONS, stratified into two groups: sepsis (n = 96) and no-sepsis (n = 104). Trans-cranial Doppler of peak systolic velocities (PSV), end diastolic velocities (EDV) and resistive indices (RI) of anterior (ACA) and middle (MCA) cerebral arteries recorded on day 1 postnatal. Griffiths mental developmental scale (GMDS) was assessed at 6 months.
Increased cNSE, PSV, EDV, and decreased RI of both ACA and MCA were found in sepsis group compared to no-sepsis group (p < 0.001 for all). Patients with SAE (n = 34) had higher NSE, PSV, and EDV as well as lower RI of ACA and MCA compared to those without (p < 0.01 for all). SAE neonates had lower GMDS than those without. ACA RI of ≤0.61 was the best predictor of SAE.
High CBF and cNSE could be useful markers for prediction of SAE. SAE impairs neurodevelopmental scales at 6 months.
败血症会导致全身炎症反应，引起脑血流（CBF）改变和血脑屏障破坏，从而导致败血症相关性脑病（SAE）。我们旨在评估早期新生儿败血症（EONS）中脐血神经元特异性烯醇化酶（cNSE）和 CBF 作为 SAE 的预测指标，并定义幸存者的短期神经发育结局。
对 200 例有 EONS 产前危险因素的新生儿进行 cNSE 测量，分为败血症组（n=96）和非败血症组（n=104）。在出生后第 1 天记录前（ACA）和中（MCA）脑动脉的收缩期峰值速度（PSV）、舒张末期速度（EDV）和阻力指数（RI）的经颅多普勒。在 6 个月时使用 Griffiths 精神发育量表（GMDS）进行评估。
与非败血症组相比，败血症组的 cNSE、PSV、EDV 升高，ACA 和 MCA 的 RI 降低（所有 p<0.001）。与无 SAE 的患者相比，患有 SAE（n=34）的患者的 NSE、PSV 和 EDV 更高，ACA 和 MCA 的 RI 更低（所有 p<0.01）。SAE 新生儿的 GMDS 评分低于无 SAE 的新生儿。ACA RI≤0.61 是 SAE 的最佳预测指标。
高 CBF 和 cNSE 可能是预测 SAE 的有用标志物。SAE 会在 6 个月时损害神经发育量表。
