Division of Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Division of Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Pediatr Neurol. 2020 Feb;103:57-60. doi: 10.1016/j.pediatrneurol.2019.08.001. Epub 2019 Aug 12.
To determine whether the use of rapid sequence magnetic resonance imaging (rsMRI) is associated with improved efficiency of care when managing infants with suspected neonatal onset seizures.
We conducted a preintervention and postintervention study of the use of rsMRI in term infants with suspected neonatal onset seizures without evidence of hypoxic ischemic encephalopathy. Study patients were collected from a contemporary cohort from 2016 to 2017 and were compared with a historical cohort from 2014. The primary outcome was hospital length of stay. Secondary outcomes included use of other imaging modalities (head ultrasound, computed tomography [CT], and MRI), use of antiseizure medications at the time of discharge, and cost of hospitalization. Continuous variables were compared using the Mann-Whitney U test and categorical variables using the Fisher's exact or χ tests. A two-tailed P < 0.05 was considered statistically significant.
Ninety-five patients met inclusion criteria, 47 in the preintervention and 48 in the postintervention group. Incorporation of the protocol-guided rsMRI in the evaluation of patients with neonatal seizures was associated with decreased use of CT scans (34% vs 10%, P = 0.007) and full MRIs (85% vs 62%, P = 0.019). Use of head ultrasound, length of stay, and costs were not different between groups.
In patients with neonatal seizures, rsMRI was not associated with a reduced hospital length of stay. The use of rsMRI resulted in fewer neonates receiving CT scans during their hospitalization. rsMRI may hasten the identification of stroke or hemorrhage in neonates with seizures.
确定在管理疑似新生儿发作性癫痫的婴儿时，使用快速序列磁共振成像（rsMRI）是否与提高护理效率相关。
我们对无缺氧缺血性脑病证据的疑似新生儿发作性癫痫的足月婴儿进行了 rsMRI 使用的干预前和干预后研究。研究患者来自 2016 年至 2017 年的当代队列，并与 2014 年的历史队列进行了比较。主要结局是住院时间。次要结局包括使用其他成像方式（头部超声、计算机断层扫描 [CT] 和 MRI）、出院时使用抗癫痫药物以及住院费用。连续变量采用 Mann-Whitney U 检验进行比较，分类变量采用 Fisher 确切检验或 χ 检验进行比较。双侧 P < 0.05 被认为具有统计学意义。
95 名患者符合纳入标准，其中干预前组 47 例，干预后组 48 例。在评估新生儿癫痫患者时纳入方案指导的 rsMRI 与 CT 扫描使用率降低相关（34%比 10%，P = 0.007）和全 MRI 使用率降低相关（85%比 62%，P = 0.019）。头超声、住院时间和费用在两组之间无差异。
在新生儿癫痫患者中，rsMRI 与住院时间缩短无关。rsMRI 的使用导致住院期间接受 CT 扫描的新生儿减少。rsMRI 可能加速对伴有癫痫发作的新生儿中风或出血的识别。
