Kim Sae Yun, Kang Hyun-Mi, Im Soo-Ah, Youn Young-Ah
Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Clinics (Sao Paulo). 2025 Jan 2;80:100533. doi: 10.1016/j.clinsp.2024.100533. eCollection 2025.
This study aimed to investigate the associations among seizures, clinical characteristics, and brain injury on Magnetic Resonance Imaging (MRI) in infants with Hypoxic Ischemic Encephalopathy (HIE), and to determine whether these findings can predict unfavorable neurodevelopmental outcomes.
Clinical and electrographic seizures were assessed by amplitude-integrated electroencephalogram, and the extent of brain injury was evaluated by using MRI. At 12‒24 months of age, developmental impairment or death was assessed. Between 2012 and 2020, 143 newborns were admitted for HIE, and 8 infants were excluded from the study.
Eighty-five infants were diagnosed with greater than moderate HIE and 65 infants underwent therapeutic hypothermia. In addition, 38 infants experienced clinical seizures (clinical seizure group, CSG), 49 infants had electrographic seizures (Electrographic Seizure Group, ESG), and 48 infants had no seizures (no seizure group, NSG). The proportion of infants with neurodevelopmental impairment or death was significantly higher in the CSG than in the NSG (57.7 % and 26.1 %, p = 0.026). A risk factor analysis indicated that cord blood pH (adjusted Odds Ratio [aOR = 0.01]; 95 % Confidence Interval [95 % CI 0.001‒0.38]; p = 0.015) and MRI findings (aOR = 4.37; 95 % CI 1.25‒15.30; p = 0.012) were independently associated with abnormal neurodevelopment, after adjustment.
Clinical seizures in infants with HIE were independently associated with abnormal neurodevelopment. However, cord blood pH and abnormal brain MRI findings were consistently linked to long-term neurodevelopmental outcomes.
本研究旨在调查缺氧缺血性脑病（HIE）婴儿的癫痫发作、临床特征与磁共振成像（MRI）脑损伤之间的关联，并确定这些发现是否能够预测不良的神经发育结局。
通过振幅整合脑电图评估临床和脑电图癫痫发作情况，并使用MRI评估脑损伤程度。在12至24个月龄时，评估发育障碍或死亡情况。2012年至2020年期间，143例新生儿因HIE入院，8例婴儿被排除在研究之外。
85例婴儿被诊断为中度以上HIE，65例婴儿接受了治疗性低温治疗。此外，38例婴儿出现临床癫痫发作（临床癫痫发作组，CSG），49例婴儿出现脑电图癫痫发作（脑电图癫痫发作组，ESG），48例婴儿无癫痫发作（无癫痫发作组，NSG）。CSG中神经发育障碍或死亡婴儿的比例显著高于NSG（57.7%和26.1%，p = 0.026）。危险因素分析表明，经调整后，脐血pH值（调整后的优势比[aOR = 0.01]；95%置信区间[95%CI 0.001 - 0.38]；p = 0.015）和MRI结果（aOR = 4.37；95%CI 1.25 - 15.30；p = 0.012）与异常神经发育独立相关。
HIE婴儿的临床癫痫发作与异常神经发育独立相关。然而，脐血pH值和异常脑MRI结果始终与长期神经发育结局相关。
