Divisions of Fetal and Transitional Medicine, Children's National Hospital, Washington, DC, USA.
Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Child Neurol. 2020 Jul;35(8):517-525. doi: 10.1177/0883073820915323. Epub 2020 Apr 20.
The objective was to examine the discriminatory ability of electroencephalogram (EEG) delta power in neonates with hypoxic-ischemic encephalopathy (HIE) with well-defined outcomes. Prolonged continuous EEG recordings from term neonates with HIE during therapeutic hypothermia enrolled in a prospective observational study were examined. Adverse outcome was defined as death or severe brain injury by magnetic resonance imaging (MRI); favorable outcome was defined as normal or mild injury by MRI. Neonates were stratified by Sarnat grade of encephalopathy at admission. EEG was partitioned into 10-minute nonoverlapping artifact- and seizure-free epochs. Delta power was calculated and compared between the groups using receiver operating characteristic (ROC) analyses and Wilcoxon rank-sum tests. An area under the ROC curve >0.7 with <.05 was considered a significant separation between groups. The favorable outcome group (n = 67) had higher delta power than the adverse outcome group (n = 28) across the majority of time periods from 9 to 90 hours of life. Delta power discriminated outcome groups for neonates with moderate encephalopathy (63 favorable and 14 adverse outcome) earlier in cooling (9-42 hours of life) than neonates with severe encephalopathy (21-42 hours of life). Outcome groups were differentiated after 81 hours of life in neonates with moderate and severe encephalopathy. Delta power can distinguish cooled HIE neonates with adverse outcome independently of the encephalopathy grade at presentation. Delta power may be a real-time continuous biomarker of evolving encephalopathy and brain injury/death in neonates with HIE.
目的是检查脑电图 (EEG) 中 δ 功率在具有明确结局的缺氧缺血性脑病 (HIE) 新生儿中的区分能力。对接受治疗性低温治疗的具有 HIE 的足月新生儿进行了前瞻性观察性研究，对其进行了长时间连续 EEG 记录。不良结局定义为死亡或磁共振成像 (MRI) 显示严重脑损伤；有利结局定义为 MRI 显示正常或轻度损伤。根据入院时的脑病 Sarnat 分级对新生儿进行分层。EEG 被分为 10 分钟不重叠的无伪迹和无痫样放电期。使用接收者操作特征 (ROC) 分析和 Wilcoxon 秩和检验比较组间的 δ 功率。ROC 曲线下面积>0.7，<0.05 被认为是组间的显著分离。在大多数生命期（9 至 90 小时），有利结局组（n = 67）的 δ 功率均高于不良结局组（n = 28）。与重度脑病（21-42 小时）新生儿相比，中度脑病（63 例有利结局和 14 例不良结局）新生儿在冷却时（9-42 小时），δ 功率更早地区分结局组。在中度和重度脑病新生儿中，在生命 81 小时后可区分结局组。δ 功率可独立于入院时的脑病分级区分具有不良结局的冷却 HIE 新生儿。δ 功率可能是 HIE 新生儿进行性脑病和脑损伤/死亡的实时连续生物标志物。
