多通道脑电图在轻度缺氧缺血性脑病婴儿前 6 小时的异常表现。
Multichannel EEG abnormalities during the first 6 hours in infants with mild hypoxic-ischaemic encephalopathy.
机构信息
INFANT Research Centre, Cork, Ireland.
Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
出版信息
Pediatr Res. 2021 Jul;90(1):117-124. doi: 10.1038/s41390-021-01412-x. Epub 2021 Apr 20.
BACKGROUND
Infants with mild HIE are at risk of significant disability at follow-up. In the pre-therapeutic hypothermia (TH) era, electroencephalography (EEG) within 6 hours of birth was most predictive of outcome. This study aims to identify and describe features of early EEG and heart rate variability (HRV) (<6 hours of age) in infants with mild HIE compared to healthy term infants.
METHODS
Infants >36 weeks with mild HIE, not undergoing TH, with EEG before 6 hours of age were identified from 4 prospective cohort studies conducted in the Cork University Maternity Services, Ireland (2003-2019). Control infants were taken from a contemporaneous study examining brain activity in healthy term infants. EEGs were qualitatively analysed by two neonatal neurophysiologists and quantitatively assessed using multiple features of amplitude, spectral shape and inter-hemispheric connectivity. Quantitative features of HRV were assessed in both the groups.
RESULTS
Fifty-eight infants with mild HIE and sixteen healthy term infants were included. Seventy-two percent of infants with mild HIE had at least one abnormal EEG feature on qualitative analysis and quantitative EEG analysis revealed significant differences in spectral features between the two groups. HRV analysis did not differentiate between the groups.
CONCLUSIONS
Qualitative and quantitative analysis of the EEG before 6 hours of age identified abnormal EEG features in mild HIE, which could aid in the objective identification of cases for future TH trials in mild HIE.
IMPACT
Infants with mild HIE currently do not meet selection criteria for TH yet may be at risk of significant disability at follow-up. In the pre-TH era, EEG within 6 hours of birth was most predictive of outcome; however, TH has delayed this predictive value. 72% of infants with mild HIE had at least one abnormal EEG feature in the first 6 hours on qualitative assessment. Quantitative EEG analysis revealed significant differences in spectral features between infants with mild HIE and healthy term infants. Quantitative EEG features may aid in the objective identification of cases for future TH trials in mild HIE.
背景
轻度新生儿缺氧缺血性脑病（HIE）患儿在随访中存在发生严重残疾的风险。在治疗前亚低温（TH）时代，出生后 6 小时内的脑电图（EEG）最能预测结局。本研究旨在比较轻度 HIE 患儿与健康足月新生儿，识别和描述其出生后 6 小时内的早期脑电图（EEG）和心率变异性（HRV）的特征。
方法
在爱尔兰科克大学妇产服务处进行的 4 项前瞻性队列研究中，确定了未行 TH 治疗、出生后 6 小时内进行 EEG 检查的＞36 周伴轻度 HIE 的患儿。对照组婴儿来自同时期一项检查健康足月婴儿脑活动的研究。由两名新生儿神经生理学家对 EEG 进行定性分析，并使用振幅、频谱形态和半球间连通性的多个特征进行定量评估。对两组的 HRV 定量特征进行评估。
结果
共纳入 58 例轻度 HIE 患儿和 16 例健康足月婴儿。72%的轻度 HIE 患儿在定性分析中至少有一项异常 EEG 特征，两组间定量 EEG 分析显示频谱特征存在显著差异。两组间 HRV 分析无差异。
结论
出生后 6 小时内的 EEG 定性和定量分析可识别轻度 HIE 的异常 EEG 特征，这有助于为未来轻度 HIE 的 TH 试验中更客观地识别病例。
意义
目前，轻度 HIE 患儿不符合 TH 的入选标准，但在随访中可能存在发生严重残疾的风险。在 TH 前时代，出生后 6 小时内的 EEG 最能预测结局；然而，TH 已延迟了这一预测价值。在定性评估中，72%的轻度 HIE 患儿在出生后 6 小时内至少有一项异常 EEG 特征。定量 EEG 分析显示，轻度 HIE 患儿与健康足月婴儿之间的频谱特征存在显著差异。定量 EEG 特征可能有助于为未来轻度 HIE 的 TH 试验更客观地识别病例。
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