Reiss Jonathan, Sinha Mridu, Gold Jeffrey, Bykowski Julie, Lawrence Shelley M
Department of Pediatrics, School of Medicine, University of California, San Diego, San Diego, California, USA.
Department of Bioengineering, University of California, San Diego, San Diego, California, USA.
Biomed Hub. 2019 Oct 10;4(3):1-9. doi: 10.1159/000502936. eCollection 2019 Sep-Dec.
Accurately diagnosing and treating infants with mild forms of hypoxic ischemic encephalopathy (HIE) is important, as the majority of neonates with signs and symptoms of HIE after birth do not meet clinical criteria for moderate or severe disease. Emerging evidence, however, suggests that infants with mild HIE (mHIE) have an increased risk for neurodevelopmental impairment (NDI).
This retrospective descriptive study examined all inborn infants ≥35 week's gestational age at a single, level III neonatal intensive care unit (NICU) in California between January 1, 2012, and December 31, 2015. International Classification of Diseases codes were used as a proxy to identify neonates with mHIE but who did not receive therapeutic hypothermia (TH). Short- and long-term neurodevelopmental outcomes were documented, including abnormal (1) brain magnetic resonance imaging within 10 days of birth suggestive of HIE, (2) electroencephalogram with electrographic seizures, (3) neurologic discharge examination, or (4) NDI following NICU discharge.
Over the 4-year study period, 25 infants met inclusion criteria. Eight of 25 (32%) infants demonstrated neurologic impairment, defined by an abnormality in at least one of the four categories. The remaining 17 infants were without documented evidence for adverse outcomes.
Our results indicate that children with mHIE are at significant risk for neurologic injury and may benefit from more aggressive interventions. Further prospective studies should be completed to determine the efficacy of TH in this specific patient population.
准确诊断和治疗轻度缺氧缺血性脑病（HIE）的婴儿很重要，因为大多数出生后有HIE体征和症状的新生儿不符合中度或重度疾病的临床标准。然而，新出现的证据表明，轻度HIE（mHIE）婴儿发生神经发育障碍（NDI）的风险增加。
这项回顾性描述性研究检查了2012年1月1日至2015年12月31日期间加利福尼亚州一家三级新生儿重症监护病房（NICU）中所有胎龄≥35周的足月儿。使用国际疾病分类代码作为识别患有mHIE但未接受治疗性低温（TH）的新生儿的替代指标。记录短期和长期神经发育结局，包括出生后10天内提示HIE的异常（1）脑磁共振成像、（2）伴有脑电图癫痫发作的脑电图、（3）神经科出院检查或（4）NICU出院后的NDI。
在4年的研究期间，25名婴儿符合纳入标准。25名婴儿中有8名（32%）表现出神经功能障碍，定义为在四个类别中的至少一个类别中存在异常。其余17名婴儿没有记录到不良结局的证据。
我们的结果表明，mHIE儿童有显著的神经损伤风险，可能受益于更积极的干预措施。应完成进一步的前瞻性研究，以确定TH在这一特定患者群体中的疗效。
