Raghu Krishna, Kalish Brian T, Tam Emily W Y, El Shahed Amr, Chau Vann, Wilson Diane, Tung Sandra, Kazazian Vanna, Miran Atiyeh A, Hahn Cecil, Branson Helen M, Ly Linh G, Cizmeci Mehmet N
Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
J Pediatr. 2025 Jan;276:114273. doi: 10.1016/j.jpeds.2024.114273. Epub 2024 Aug 30.
To investigate the clinical, electrographic, and neuroimaging characteristics in neonates with perinatal hypoxic-ischemic encephalopathy who underwent reorientation of care using standardized scoring systems.
A nested observational substudy within a prospective hypoxic-ischemic encephalopathy cohort was conducted. Group 1 comprised infants whose parents received the medical recommendation for reorientation of care, while group 2 continued to receive standard care. Encephalopathy scores were monitored daily. Amplitude-integrated and continuous-video-integrated electroencephalogram during therapeutic hypothermia were analyzed. Standardized scoring systems for cranial ultrasonography and postrewarming brain magnetic resonance imaging were deployed.
The study included 165 infants, with 35 in group 1 and 130 in Group 2. By day 3, all infants in group 1 were encephalopathic with higher Thompson scores (median 13 [IQR 10-19] vs 0 [IQR 0-3], P < .001). Electrographic background normalization within 48 hours occurred in 3% of group 1 compared with 46% of group 2 (P < .001). Sleep-wake cycling was not observed in group 1 and emerged in 63% of group 2 within the first 72 hours (P < .001). The number of antiseizure medications received was higher in group 1 (median 3 [IQR, 2-4] vs 0 [IQR, 0-1], respectively; P < .001). Group 1 had higher cranial ultrasound injury scores (median 4 [IQR 2-7] vs 1 [IQR 0-1], P < .001) within 48 hours and postrewarming brain magnetic resonance imaging injury scores (median 33 [range 20-51] vs 4 [range 0-28], P < .001).
Neonates with perinatal hypoxic-ischemic encephalopathy who underwent reorientation of care presented with and maintained significantly more pronounced clinical manifestations, electrographic findings, and near-total brain injury as scored objectively on all modalities.
Registration of the study cohort: NCT04913324.
研究使用标准化评分系统对围产期缺氧缺血性脑病新生儿进行护理调整后的临床、脑电图及神经影像学特征。
在前瞻性缺氧缺血性脑病队列中进行了一项嵌套观察性子研究。第1组包括父母接受护理调整医疗建议的婴儿，而第2组继续接受标准护理。每天监测脑病评分。分析治疗性低温期间的振幅整合脑电图和连续视频整合脑电图。采用标准化的头颅超声评分系统和复温后脑磁共振成像评分系统。
该研究纳入165例婴儿，第1组35例，第2组130例。到第3天，第1组所有婴儿均患有脑病，汤普森评分更高（中位数13 [四分位间距10 - 19] 对比0 [四分位间距0 - 3]，P <.001）。第1组48小时内脑电图背景正常化的比例为3%，而第2组为46%（P <.001）。第1组未观察到睡眠 - 觉醒周期，第2组在前72小时内63%出现了睡眠 - 觉醒周期（P <.001）。第1组接受抗癫痫药物的数量更多（中位数分别为3 [四分位间距，2 - 4] 对比0 [四分位间距，0 - 1]；P <.001）。第1组在48小时内头颅超声损伤评分更高（中位数4 [四分位间距2 - 7] 对比1 [四分位间距0 - 1]，P <.001），复温后脑磁共振成像损伤评分也更高（中位数33 [范围20 - 51] 对比4 [范围0 - 28]，P <.001）。
接受护理调整的围产期缺氧缺血性脑病新生儿在所有模式下客观评分显示，其临床表现、脑电图表现及近乎全脑损伤更为明显且持续存在。
研究队列注册编号：NCT04913324。
