School of Data Science, University of Virginia, Charlottesville, Virginia.
Department of Mathematics, College of William & Mary, Williamsburg, Virginia.
Am J Perinatol. 2022 Feb;39(3):288-297. doi: 10.1055/s-0040-1715822. Epub 2020 Aug 20.
This study aimed to evaluate the role of an objective physiologic biomarker, arterial blood pressure variability, for the early identification of adverse short-term electroencephalogram (EEG) outcomes in infants with hypoxic-ischemic encephalopathy (HIE).
In this multicenter observational study, we analyzed blood pressure of infants meeting these criteria: (1) neonatal encephalopathy determined by modified Sarnat exam, (2) continuous mean arterial blood pressure (MABP) data between 18 and 27 hours after birth, and (3) continuous EEG performed for at least 48 hours. Adverse outcome was defined as moderate-severe grade EEG at 48 hours. Standardized signal preprocessing was used; the power spectral density was computed without interpolation. Multivariate binary logistic regression was used to identify which MABP time and frequency domain metrics provided improved predictive power for adverse outcomes compared with standard clinical predictors (5-minute Apgar score and cord pH) using receiver operator characteristic analysis.
Ninety-one infants met inclusion criteria. The mean gestational age was 38.4 ± 1.8 weeks, the mean birth weight was 3,260 ± 591 g, 52/91 (57%) of infants were males, the mean cord pH was 6.95 ± 0.21, and 10/91 (11%) of infants died. At 48 hours, 58% of infants had normal or mildly abnormal EEG background and 42% had moderate or severe EEG backgrounds. Clinical predictor variables (10-minute Apgar score, Sarnat stage, and cord pH) were modestly predictive of 48 hours EEG outcome with area under curve (AUC) of 0.66 to 0.68. A composite model of clinical and optimal time- and frequency-domain blood pressure variability had a substantially improved AUC of 0.86.
Time- and frequency-domain blood pressure variability biomarkers offer a substantial improvement in prediction of later adverse EEG outcomes over perinatal clinical variables in a two-center cohort of infants with HIE.
· Early outcome prediction in HIE is suboptimal.. · Patterns in blood pressure physiology may be predictive of short-term outcomes.. · Early time- and frequency-domain measures of blood pressure variability predict short-term EEG outcomes in HIE infants better than perinatal factors alone..
本研究旨在评估动脉血压变异性这一客观生理生物标志物在预测缺氧缺血性脑病（HIE）婴儿短期不良脑电图（EEG）结局方面的作用。
在这项多中心观察性研究中，我们分析了符合以下标准的婴儿的血压数据：（1）通过改良 Sarnat 检查确定的新生儿脑病，（2）出生后 18 至 27 小时的连续平均动脉血压（MABP）数据，以及（3）至少进行 48 小时的连续 EEG。不良结局定义为 48 小时时中度至重度 EEG 分级。使用标准化信号预处理；在计算功率谱密度时不进行插值。使用受试者工作特征分析，采用多变量二项逻辑回归确定与标准临床预测因子（5 分钟 Apgar 评分和脐带 pH）相比，哪些 MABP 时间和频域指标可提供更好的预测不良结局的能力。
91 名婴儿符合纳入标准。平均胎龄为 38.4±1.8 周，平均出生体重为 3260±591g，91 名婴儿中有 52/91（57%）为男性，脐带 pH 为 6.95±0.21，10/91（11%）的婴儿死亡。48 小时时，58%的婴儿脑电图背景正常或轻度异常，42%的婴儿脑电图背景为中度或重度异常。临床预测变量（10 分钟 Apgar 评分、Sarnat 分期和脐带 pH）对 48 小时脑电图结局的预测能力中等，曲线下面积（AUC）为 0.66 至 0.68。包含临床和最佳时频域血压变异性的综合模型 AUC 显著提高至 0.86。
在 HIE 的两中心队列中，与围产期临床变量相比，时间和频域血压变异性生物标志物在预测后期不良 EEG 结局方面有显著改善。
·HIE 的早期预后结果并不理想。·血压生理模式可能可预测短期结局。·HIE 婴儿早期时频域血压变异性测量值比单独的围产期因素更能预测短期 EEG 结局。
