脑电图谱功率与新生儿脑病后血糖异常与神经发育结局的关系。

Relationship between EEG spectral power and dysglycemia with neurodevelopmental outcomes after neonatal encephalopathy.

机构信息

Neurodevelopmental Optical Imaging Laboratory (LION Lab), Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Research Centre, Sainte-Justine University Hospital Centre, Montreal, QC, Canada; Department of Psychology, University of Montreal, Montreal, QC, Canada.

出版信息

Clin Neurophysiol. 2024 Jul;163:160-173. doi: 10.1016/j.clinph.2024.03.029. Epub 2024 Apr 6.

DOI:10.1016/j.clinph.2024.03.029

PMID:38754181

Abstract

OBJECTIVE

We investigated how electroencephalography (EEG) quantitative measures and dysglycemia relate to neurodevelopmental outcomes following neonatal encephalopathy (NE).

METHODS

This retrospective study included 90 neonates with encephalopathy who received therapeutic hypothermia. EEG absolute spectral power was calculated during post-rewarming and 2-month follow-up. Measures of dysglycemia (hypoglycemia, hyperglycemia, and glycemic lability) and glucose variability were computed for the first 48 h of life. We evaluated the ability of EEG and glucose measures to predict neurodevelopmental outcomes at ≥ 18 months, using logistic regressions (with area under the receiver operating characteristic [AUROC] curves).

RESULTS

The post-rewarming global delta power (average all electrodes), hyperglycemia and glycemic lability predicted moderate/severe neurodevelopmental outcome separately (AUROC = 0.8, 95%CI [0.7,0.9], p < .001) and even more so when combined (AUROC = 0.9, 95%CI [0.8,0.9], p < .001). After adjusting for NE severity and magnetic resonance imaging (MRI) brain injury, only global delta power remained significantly associated with moderate/severe neurodevelopmental outcome (odds ratio [OR] = 0.9, 95%CI [0.8,1.0], p = .04), gross motor delay (OR = 0.9, 95%CI [0.8,1.0], p = .04), global developmental delay (OR = 0.9, 95%CI [0.8,1.0], p = .04), and auditory deficits (OR = 0.9, 95%CI [0.8,1.0], p = .03).

CONCLUSIONS

In NE, global delta power post-rewarming was predictive of outcomes at ≥ 18 months.

SIGNIFICANCE

EEG markers post-rewarming can aid prediction of neurodevelopmental outcomes following NE.

摘要

目的

本研究旨在探讨脑电图（EEG）定量指标与新生儿脑病（NE）后神经发育结局的相关性，并分析血糖异常与神经发育结局的关系。

方法

本回顾性研究纳入了 90 例接受亚低温治疗的脑病患儿。在复温后和 2 个月随访时计算绝对光谱功率。计算新生儿生后前 48 小时内的血糖异常（低血糖、高血糖和血糖波动）和葡萄糖变异性的相关指标。采用逻辑回归（受试者工作特征曲线下面积[AUC]）评估 EEG 和血糖指标预测≥18 个月时神经发育结局的能力。

结果

复温后全局δ功率（所有电极平均值）、高血糖和血糖波动可单独预测中重度神经发育结局（AUC=0.8，95%CI [0.7，0.9]，p<0.001），联合预测的效能更高（AUC=0.9，95%CI [0.8，0.9]，p<0.001）。在校正 NE 严重程度和磁共振成像（MRI）脑损伤后，仅全局δ功率与中重度神经发育结局显著相关（比值比[OR]，0.9；95%CI [0.8，1.0]；p=0.04），与粗大运动延迟（OR，0.9；95%CI [0.8，1.0]；p=0.04）、全面发育迟缓（OR，0.9；95%CI [0.8，1.0]；p=0.04）和听觉缺陷（OR，0.9；95%CI [0.8，1.0]；p=0.03）也显著相关。