Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
Seizure. 2018 Oct;61:221-226. doi: 10.1016/j.seizure.2018.09.003. Epub 2018 Sep 11.
Electroencephalographic seizures (ES) are common among neonates with hypoxic-ischemic encephalopathy (HIE), and they represent a treatable complication that might improve neurodevelopmental outcomes. We aimed to establish whether higher ES exposure was predictive of unfavorable outcomes while adjusting for other important clinical and electroencephalographic parameters.
We performed a single-center, retrospective study of consecutive neonates with HIE managed with therapeutic hypothermia from June 2010 through December 2016. Neonates underwent continuous electroencephalographic (cEEG) monitoring during and after therapeutic hypothermia. Outcome measures included abnormal MRIs after rewarming and abnormal motor and language development.
Clinical data from the perinatal period were available for 116 neonates. Follow-up data were available for 93 of 116 (80%) neonates who survived to discharge, with a median follow-up period of 23 months (interquartile range 1236 months). Multivariate analysis demonstrated that high ES exposure (OR 5.2, 95% CI 1.3-21.2, p = 0.02) and moderate/severely abnormal EEG background (OR 8.3, 95% CI 1.6-43.9, p = 0.01) were independent predictors of abnormal motor development. High ES exposure was an independent predictor of abnormal language development (OR 4.2, 95% CI 1.1-15.9, p = 0.04). High ES exposure (OR 7.0, 95% CI 2.2-22.5, p = 0.01) and severe encephalopathy (OR 7.9, 95% CI 1.5-42.7, p = 0.02) were independent predictors of abnormal MRIs.
Among neonates with HIE managed with therapeutic hypothermia, high ES exposure was the most important predictor of abnormal developmental and neuroimaging outcomes, even after adjustment for multiple clinical and EEG variables. Adequate identification and management of ES with judicious use of anti-seizure medications may optimize outcomes.
脑电图癫痫发作（ES）在患有缺氧缺血性脑病（HIE）的新生儿中很常见，它们是一种可治疗的并发症，可能改善神经发育结局。我们旨在确定更高的 ES 暴露是否在调整其他重要临床和脑电图参数后具有不良结局的预测价值。
我们进行了一项单中心、回顾性研究，纳入了 2010 年 6 月至 2016 年 12 月期间接受治疗性低温治疗的连续患有 HIE 的新生儿。新生儿在治疗性低温期间和之后进行连续脑电图（cEEG）监测。结局测量包括复温后异常 MRI 和运动、语言发育异常。
116 例新生儿的围产期临床数据可用于分析。116 例新生儿中，有 93 例（80%）存活至出院并可获得随访数据，中位随访时间为 23 个月（四分位距 1236 个月）。多变量分析表明，高 ES 暴露（OR 5.2，95%CI 1.3-21.2，p=0.02）和中度/重度脑电图背景异常（OR 8.3，95%CI 1.6-43.9，p=0.01）是运动发育异常的独立预测因素。高 ES 暴露是语言发育异常的独立预测因素（OR 4.2，95%CI 1.1-15.9，p=0.04）。高 ES 暴露（OR 7.0，95%CI 2.2-22.5，p=0.01）和严重脑病（OR 7.9，95%CI 1.5-42.7，p=0.02）是异常 MRI 的独立预测因素。
在接受治疗性低温治疗的患有 HIE 的新生儿中，高 ES 暴露是发育和神经影像学结局异常的最重要预测因素，即使在调整了多个临床和脑电图变量后也是如此。通过明智地使用抗癫痫药物充分识别和管理 ES，可能会优化结局。
