复温期间的惊厥严重程度可预测接受治疗性低温治疗的新生儿缺氧缺血性脑病婴儿的惊厥结局。
Seizures severity during rewarming can predict seizure outcomes of infants with neonatal hypoxic-ischemic encephalopathy following therapeutic hypothermia.
机构信息
Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; Study Group of Intensive and Integrated Care for Pediatric Central Nervous System (iCNS Group), Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Division of Neonatology, Department of Pediatrics, Chang Gung Children's Hospital at Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Study Group of Intensive and Integrated Care for Pediatric Central Nervous System (iCNS Group), Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
Biomed J. 2020 Jun;43(3):285-292. doi: 10.1016/j.bj.2020.06.008. Epub 2020 Jun 30.
BACKGROUND
The aim of this study was to examine the predictive value of amplitude-integrated electroencephalography (aEEG) on 12-month seizure outcomes of infants with neonatal hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia.
METHODS
We conducted this retrospective cohort study in a tertiary neonatal intensive care unit between May 2012 and September 2017. Neonates with HIE who received both therapeutic hypothermia (TH) and aEEG were enrolled.
RESULTS
A total of 23 infants (14 boys, nine girls) with a mean gestational age of 38.9 weeks were enrolled. Fifteen (65%) infants had moderate HIE and eight (35%) had severe HIE according to modified Sarnat staging. The mean aEEG recording time was 107.5 h. Twenty (86.9%) infants had seizure activity during the first 24 h after cooling and 14 (60.8%) had seizure activity during the first 24 h after rewarming. At 12 months, five (21.7%) infants had poor seizure outcomes. Repetitive seizures or status epilepticus pattern during the first 24 h after rewarming, but not the first 24 h after cooling, were associated with the presence of epilepsy at 12 months (p = 0.037).
CONCLUSIONS
We identified a high incidence of electrographic seizures in infants with neonatal HIE treated with therapeutic hypothermia, and post-neonatal epilepsy in the children who survived after HIE. Repetitive seizures or status epilepticus pattern during the first 24 h after rewarming, but not in the first 24 h after cooling, were associated with the presence of epilepsy at 12 months.
背景
本研究旨在探讨接受治疗性低温治疗的新生儿缺氧缺血性脑病（HIE）患儿振幅整合脑电图（aEEG）对 12 个月时癫痫发作结局的预测价值。
方法
我们在 2012 年 5 月至 2017 年 9 月期间在一家三级新生儿重症监护病房进行了这项回顾性队列研究。纳入接受治疗性低温治疗（TH）和 aEEG 的 HIE 新生儿。
结果
共纳入 23 名婴儿（14 名男婴，9 名女婴），平均胎龄为 38.9 周。根据改良 Sarnat 分期，15 名（65%）婴儿为中度 HIE，8 名（35%）婴儿为重度 HIE。aEEG 记录时间平均为 107.5 小时。20 名（86.9%）婴儿在冷却后 24 小时内有癫痫发作，14 名（60.8%）婴儿在复温后 24 小时内有癫痫发作。12 个月时，5 名（21.7%）婴儿癫痫发作结局较差。复温后 24 小时内出现反复癫痫发作或癫痫持续状态模式，而不是冷却后 24 小时内，与 12 个月时存在癫痫有关（p=0.037）。
结论
我们发现接受治疗性低温治疗的新生儿 HIE 患儿存在较高的脑电图癫痫发作发生率，且 HIE 存活后儿童出现新生儿期后癫痫。复温后 24 小时内出现反复癫痫发作或癫痫持续状态模式，而不是冷却后 24 小时内，与 12 个月时存在癫痫有关。
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