缺氧缺血性脑病伴或不伴脑损伤新生儿的第2天超声心动图检查及心血管生物标志物测量
Day-2 echocardiography and cardiovascular biomarkers measurements in neonates with hypoxic-ischemic encephalopathy with or without brain injury.
作者信息
Lapointe Anie, Wintermark Pia, Rampakakis Emmanouil, Wutthigate Punnannee, Moore Shiran Sara, Simoneau Jessica, Altit Gabriel
机构信息
Department of Neonatology, Sainte-Justine Hospital, Montreal, QC, Canada.
Department of Neonatology, Montreal Children's Hospital, Montreal, QC, Canada.
出版信息
J Perinatol. 2025 Sep 19. doi: 10.1038/s41372-025-02419-6.
OBJECTIVE
To assess the association between day-2 cardiac function and brain injury in neonates with HIE undergoing therapeutic hypothermia.
STUDY DESIGN
A prospective single-center study (2016-2021) including neonates ≥36 weeks gestation with moderate to severe HIE treated with TH. Brain injuries were evaluated using MRI and a validated scoring system, and logistic regression identified cardiovascular predictors.
RESULTS
Among 55 neonates, 33 (60%) had brain injuries. Day-2 ventricular dysfunction was found in 16 (29%). Neonates with brain injuries had higher gestational age, more severe aEEG patterns, and higher Sarnat scores. Significant predictors of brain injury included higher gestational age, severe initial aEEG patterns, and increased left ventricular strain. No significant differences were observed in standard echocardiography measurements.
CONCLUSION
Severe initial aEEG patterns and increased left ventricular strain, rather than day-2 cardiac dysfunction, were more predictive of brain injury in HIE neonates. Early assessments may further clarify the role of hemodynamics.
目的
评估接受治疗性低温治疗的新生儿缺氧缺血性脑病（HIE）患儿第2天的心功能与脑损伤之间的关联。
研究设计
一项前瞻性单中心研究（2016 - 2021年），纳入孕周≥36周、接受低温治疗的中度至重度HIE新生儿。使用磁共振成像（MRI）和经过验证的评分系统评估脑损伤情况，并通过逻辑回归确定心血管预测因素。
结果
55例新生儿中，33例（60%）有脑损伤。16例（29%）在第2天出现心室功能障碍。有脑损伤的新生儿孕周更大，振幅整合脑电图（aEEG）模式更严重，且Sarnat评分更高。脑损伤的显著预测因素包括孕周更大、初始aEEG模式严重以及左心室应变增加。标准超声心动图测量未观察到显著差异。
结论
对于HIE新生儿，初始aEEG模式严重和左心室应变增加比第2天的心功能障碍更能预测脑损伤。早期评估可能会进一步阐明血流动力学的作用。
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