Lugli Licia, Guidotti Isotta, Pugliese Marisa, Roversi Maria Federica, Bedetti Luca, Della Casa Muttini Elisa, Cavalleri Francesca, Todeschini Alessandra, Genovese Maurilio, Ori Luca, Amato Maria, Miselli Francesca, Lucaccioni Laura, Bertoncelli Natascia, Candia Francesco, Maura Tommaso, Iughetti Lorenzo, Ferrari Fabrizio, Berardi Alberto
Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy.
Psychology Unit, University Hospital of Modena, 41100 Modena, Italy.
Children (Basel). 2022 Aug 9;9(8):1194. doi: 10.3390/children9081194.
Neonatal encephalopathy due to perinatal asphyxia is one of the leading causes of neonatal death and morbidity worldwide. The neurodevelopmental outcomes of asphyxiated neonates have considerably improved after therapeutic hypothermia (TH). The current challenge is to identify all newborns with encephalopathy at risk of cerebral lesions and subsequent disability within 6 h of life and who may be within the window period for treatment with TH. This study evaluated the neurodevelopmental outcomes in surviving asphyxiated neonates who did and did not receive TH, based on clinical and polygraphic electroencephalographic (p-EEG) criteria. The study included 139 asphyxiated newborns divided into two groups: 82 who received TH and 57 who were not cooled. TH was administered to asphyxiated newborns (gestational age ≥ 35 weeks, birth weight ≥ 1800 g) with encephalopathy of any grade and moderate-to-severe p-EEG abnormalities or seizures. Neurodevelopmental outcomes between the groups at 24 months of life and the risk factors for severe outcomes were assessed. Severe neurodevelopmental impairment occurred in 10 (7.2%) out of the 139 enrolled neonates. Nine out of the 82 cooled neonates (11.0%) had severe neurodevelopmental impairment. All but one neonate (98.2%) who did not receive TH had normal outcomes. The multivariate logistic regression analysis showed that abnormal p-EEG patterns (OR: 27.6; IC: 2.8-267.6) and general movements (OR: 3.2; IC: 1.0-10.0) were significantly associated with severe neurodevelopmental impairment (area under ROC curve: 92.7%). The combination of clinical and p-EEG evaluations in hypoxic-ischemic encephalopathy contributed to a more accurate selection of patients treated with therapeutic hypothermia. When administered to infants with moderate to severe p-EEG abnormalities, TH prevents approximately 90% of severe neurodevelopmental impairment after any grade of hypoxic-ischemic encephalopathy.
围产期窒息所致新生儿脑病是全球新生儿死亡和发病的主要原因之一。治疗性低温（TH）后，窒息新生儿的神经发育结局有了显著改善。当前的挑战是在出生后6小时内识别出所有有脑病且有脑损伤风险及后续残疾风险、可能处于TH治疗窗口期的新生儿。本研究根据临床和多导睡眠脑电图（p-EEG）标准，评估了接受和未接受TH的存活窒息新生儿的神经发育结局。该研究纳入了139例窒息新生儿，分为两组：82例接受TH治疗，57例未进行降温处理。TH应用于任何级别的脑病且伴有中度至重度p-EEG异常或惊厥的窒息新生儿（胎龄≥35周，出生体重≥1800g）。评估了两组在24个月时的神经发育结局以及严重结局的危险因素。139例纳入研究的新生儿中有10例（7.2%）出现严重神经发育障碍。82例接受降温治疗的新生儿中有9例（11.0%）出现严重神经发育障碍。未接受TH治疗的新生儿中，除1例（98.2%）外，其余结局均正常。多因素logistic回归分析显示，异常p-EEG模式（OR：27.6；IC：2.8 - 267.6）和一般运动（OR：3.2；IC：1.0 - 10.0）与严重神经发育障碍显著相关（ROC曲线下面积：92.7%）。在缺氧缺血性脑病中，临床和p-EEG评估相结合有助于更准确地选择接受治疗性低温治疗的患者。当应用于中度至重度p-EEG异常的婴儿时，TH可预防任何级别的缺氧缺血性脑病后约90%的严重神经发育障碍。
