Department of Neonatology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2021;23(9):909-915. doi: 10.7499/j.issn.1008-8830.2105054.
To study the correlation of electroencephalogram (EEG) background evolution with the degree of brain injury in neonates with hypoxic-ischemic encephalopathy (HIE).
A retrospective analysis was performed for 56 neonates with HIE who underwent continuous video electroencephalogram (cVEEG) and brain magnetic resonance imaging (MRI) examinations. According to clinical symptoms, they were divided into a mild group with 3 neonates, a moderate group with 36 neonates, and a severe group with 17 neonates. EEG background grading and MRI score were determined for each group to analyze the correlation of EEG background evolution with the degree of brain injury.
Compared with the moderate group, the severe group had significantly lower gestational age and Apgar score at 5 minutes after birth, a significantly higher resuscitation score, significantly lower base excess in umbilical cord blood or blood gas within 1 hour, a significantly higher proportion of neonates on mechanical ventilation, and a significantly higher incidence rate of short-term adverse outcomes (<0.05). For the neonates in the mild and moderate groups, MRI mainly showed no brain injury (67%, 2/3) and watershed injury (67%, 16/24) respectively, and EEG showed mild abnormality in 62% (13/21) of the neonates on the 3rd day after birth. For the neonates in the severe group, MRI mainly showed basal ganglia/thalamus + brainstem injury (24%, 4/17) and whole brain injury (71%, 12/17), and EEG showed moderate or severe abnormalities on the 3rd day after birth. EEG background grading was correlated with clinical grading, MRI score, and short-term outcome on days 1, 2, 3 and 7-14 after birth (<0.01). The highest correlation coefficient between EEG grading and MRI score was observed on the 3rd day after birth (=0.751, <0.001), and the highest correlation coefficients between EEG grading and clinical grading (=0.592, =0.002) and between EEG grading and short-term outcome (=0.737, <0.001) were observed 7-14 days after birth. Among the neonates with severe abnormal EEG, the neonates without brain electrical activity had the highest MRI score, followed by those with status epileptics and persistent low voltage (<0.05).
There is a good correlation between EEG background grading and degree of brain injury in neonates with HIE, which can help to evaluate the degree and prognosis of brain injury in the early stage.
研究脑电图（EEG）背景演变与新生儿缺氧缺血性脑病（HIE）脑损伤程度的相关性。
回顾性分析 56 例接受连续视频脑电图（cVEEG）和脑磁共振成像（MRI）检查的 HIE 新生儿。根据临床症状，将其分为轻度组（3 例）、中度组（36 例）和重度组（17 例）。对每组进行脑电图背景分级和 MRI 评分，分析脑电图背景演变与脑损伤程度的相关性。
与中度组相比，重度组新生儿的胎龄和出生后 5 分钟时的 Apgar 评分明显较低，复苏评分明显较高，脐血或血气 1 小时内的基础不足明显较低，机械通气的新生儿比例明显较高，短期不良结局的发生率明显较高（<0.05）。对于轻度和中度组的新生儿，MRI 主要显示无脑损伤（67%，2/3）和分水岭损伤（67%，16/24），脑电图在出生后第 3 天显示 62%（13/21）的新生儿轻度异常。对于重度组的新生儿，MRI 主要显示基底节/丘脑+脑干损伤（24%，4/17）和全脑损伤（71%，12/17），脑电图在出生后第 3 天显示中度或重度异常。脑电图背景分级与出生后 1、2、3 天和 7-14 天的临床分级、MRI 评分和短期结局呈显著相关（<0.01）。出生后第 3 天，脑电图分级与 MRI 评分的相关系数最高（=0.751，<0.001），与临床分级（=0.592，=0.002）和短期结局（=0.737，<0.001）的相关性最高。在重度异常脑电图的新生儿中，无脑电活动的新生儿 MRI 评分最高，其次是癫痫状态和持续低电压的新生儿（<0.05）。
脑电图背景分级与 HIE 新生儿脑损伤程度具有良好的相关性，有助于早期评估脑损伤程度和预后。
