Pediatric Department, Alexandria University Hospital, Alexandria, Egypt.
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Am J Perinatol. 2024 Mar;41(4):429-438. doi: 10.1055/s-0041-1740513. Epub 2021 Dec 29.
Hypoxic-ischemic encephalopathy (HIE) affects millions of newborns annually, especially in low-resource settings. Real-time monitoring of hypoxic-ischemic brain damage is urgently needed for assessment of severity and management of neonates with birth asphyxia. Aim of the work is monitoring of near-infrared spectroscopy (NIRS)-measured cerebral regional oxygen saturation (cRSO and cerebral fractional tissue oxygen extraction (FTOE) in neonates after birth asphyxia in relation to their clinical course.
Forty asphyxiated-term and near-term neonates with mild to severe HIE admitted at neonatal intensive care unit of Alexandria University Maternity Hospital from March to October 2019, received therapeutic hypothermia (TH) and had continuous NIRS monitoring of cRSO for 72 hours. Infants were categorized into HIE with seizing and nonseizing groups, and abnormal and normal magnetic resonance imaging (MRI) groups.
Clinical seizures (CS) occurred in 15 (37.5%) of HIE neonates and 13.3% of them died ( = 2). In the current study, significantly higher cRSO and lower FTOE values were found in the seizing infants as compared with nonseizing group ( < 0.001). NIRS-measured day 2-cRSO and day 1-FTOE were associated with CS in newborns with HIE and day 1-cRSO and FTOE were associated with abnormal MRI at 1 month of age. cRSO values were found to correlate positively with initial Thompson score especially in days 1 and 2. Further, neonates with CS were more likely to have MRI abnormalities at follow-up.
NIRS measures may highlight differences between asphyxiated neonates who develop CS or later MRI abnormalities and those who do not.
· Day 1 FTOE is the early and sensitive predictor for both clinical seizures and abnormal MRI.. · Cerebral oxygenation metrics help in selecting patients in urgent need of an early MRI scan.. · Cerebral oxygenation metrics can be used hand in hand with clinical assessment using Thompson score at admission to select patient candidate for therapeutic hypothermia..
缺氧缺血性脑病（HIE）每年影响数百万新生儿，尤其是在资源匮乏的环境中。对于出生窒息的新生儿，迫切需要实时监测缺氧缺血性脑损伤，以评估其严重程度并进行管理。本研究旨在监测出生窒息后新生儿近红外光谱（NIRS）测量的脑区域性氧饱和度（cRSO）和脑局部组织氧摄取分数（FTOE）与临床病程的关系。
2019 年 3 月至 10 月，亚历山大大学妇产医院新生儿重症监护病房收治了 40 例轻度至重度 HIE 的窒息足月和近足月新生儿，接受了治疗性低体温（TH）治疗，并连续 72 小时进行 cRSO 的 NIRS 监测。将婴儿分为有癫痫发作和无癫痫发作组，以及异常和正常磁共振成像（MRI）组。
HIE 新生儿中有 15 例（37.5%）出现临床癫痫发作（CS），其中 13.3%死亡（=2）。在本研究中，与无癫痫发作组相比，有癫痫发作的婴儿 cRSO 更高，FTOE 更低（ < 0.001）。NIRS 测量的第 2 天 cRSO 和第 1 天 FTOE 与 HIE 新生儿的 CS 相关，第 1 天 cRSO 和 FTOE 与 1 个月时的异常 MRI 相关。cRSO 值与初始汤普森评分呈正相关，尤其是在第 1 天和第 2 天。此外，有 CS 的新生儿在随访时更有可能出现 MRI 异常。
NIRS 测量值可能突出了出现 CS 或后续 MRI 异常的窒息新生儿与未出现这些情况的新生儿之间的差异。
·第 1 天 FTOE 是临床癫痫发作和异常 MRI 的早期和敏感预测指标。
·脑氧合指标有助于选择急需早期 MRI 扫描的患者。
·脑氧合指标可以与入院时使用汤普森评分进行的临床评估一起使用，以选择候选接受治疗性低温治疗的患者。
