Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan.
Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Medicine (Baltimore). 2021 Mar 26;100(12):e25118. doi: 10.1097/MD.0000000000025118.
The aim was to examine whether clinical seizures and amplitude-integrated electroencephalogram (aEEG) patterns in infants with hypoxic ischemic encephalopathy (HIE) can predict the extent of brain injury on magnetic resonance images (MRI) and the long-term neurodevelopmental outcomes at 18∼24 months of age.HIE infants who underwent therapeutic hypothermia (TH) between June 2014 and March 2017 were included in this study. Infants with clinical seizure were analyzed for aEEG patterns and the extent of brain injury on MRI findings. Clinical seizure, aEEG, and brain MRI were assessed and compared with neurodevelopmental outcomes at 18∼24 months of age.Among the 97 HIE infants enrolled in this study with brain MRI scans, 78 (73.1%) TH-treated HIE infants exhibited clinical seizures. More abnormalities on a EEGs and more significant use of first and second antiepileptic drugs (AEDs) were significantly higher in the clinical-seizure group with longer hospitalized days. At a corrected 18 to 24 months of age, HIE infants in the clinical-seizure group with more extension of injury lesions on diffusion-weighted MRI scans exhibited significantly more delayed neurodevelopment. A risk factor analysis indicated that male infants who stayed in the hospital for more than 11 days were at a higher risk of having clinical seizures. The lesion size in MRI greater than 37 pixels was a risk factor with an 81.8% accuracy.Seizures in HIE infants may predict abnormal brain MRI scans and abnormal neurodevelopment at 18 to 24 months of age.
目的在于研究患有缺氧缺血性脑病（HIE）的婴儿的临床发作和振幅整合脑电图（aEEG）模式是否可以预测磁共振成像（MRI）上的脑损伤程度以及 18 至 24 个月时的长期神经发育结局。本研究纳入了 2014 年 6 月至 2017 年 3 月期间接受亚低温治疗（TH）的 HIE 婴儿。对出现临床发作的婴儿进行了 aEEG 模式分析和 MRI 脑损伤程度分析。评估了临床发作、aEEG 和脑 MRI，并与 18 至 24 个月时的神经发育结局进行了比较。在本研究纳入的 97 例有脑 MRI 扫描的 HIE 婴儿中，78 例（73.1%）TH 治疗的 HIE 婴儿出现了临床发作。在住院时间较长的临床发作组中，aEEG 异常更多，首次和二次抗癫痫药物（AED）的使用率更高。在矫正后的 18 至 24 个月时，在弥散加权 MRI 扫描中损伤病变扩展更多的临床发作组的 HIE 婴儿表现出明显的神经发育延迟。风险因素分析表明，住院时间超过 11 天的男性婴儿发生临床发作的风险更高。MRI 病变大小大于 37 像素是一个具有 81.8%准确性的风险因素。HIE 婴儿的发作可能预示着 MRI 扫描异常和 18 至 24 个月时的神经发育异常。
