Cerebral regional oxygen saturation trends in infants with hypoxic-ischemic encephalopathy
Cerebral regional oxygen saturation trends in infants with hypoxic-ischemic encephalopathy
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DOI：
10.1016/j.earlhumdev.2017.07.008
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发表时间：
2017-10-01
影响因子：
2.5
通讯作者：
Engelhardt, Barbara
中科院分区：
文献类型：
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作者：
Jain, Siddharth V.;Pagano, Lindsay;Engelhardt, Barbara
背景：尽管低温治疗（TH），新生儿缺氧缺血性脑病（HIE）的神经系统预后仍然不理想。大脑近红外光谱提供实时区域氧饱和度（CrSO2），可能是不良MRI结果和神经发育结局的标志。目的：本研究的目的是探讨CrSO2监测在HIE患儿行TH治疗中的价值。研究设计和对象：在这项前瞻性研究中，连续记录21例因TH入院的HIE婴儿的CrSO2。结果测量：对2周脑MRI信号异常进行单独脑区评分，并将其分为无/轻度、中度和重度。13名婴儿在18-24个月完成Bayley婴儿发育量表（BSID）测试。结果：在24至36小时的生命中，出现中度至重度脑MRI异常且CrSO2绝对值较高的几率显著增加。绝对CrSO2每增加10%，中重度脑MRI异常的优势比在30小时最大（OR 3.78；置信区间（CI）： 1.23-11.6, p = 0.011）。MRI损伤程度越严重的婴儿CrSO2升高越快（MRI评分0/1为0.20/h， MRI评分2为0.48/h， MRI评分3为0.68/h, p = 0.05）。30h时，CrSO2绝对值与基底节区（92% vs. 78%, p = 0.001）、白质（88% vs. 76%, p = 0.01）、内囊后肢MRI异常表现显著相关。（92% vs. 78%, p = 0.001）和脑干（94% vs. 80%, p = 0.03），但没有皮质损伤（86% vs. 80%, p = 0.17）。24 h以上CrSO2越高，BSID评分越差的几率越大。结论：通过MRI评估，CrSO2升高与中重度脑损伤相关。TH期间较高的绝对CrSO2值与MRI显示的皮质下损伤和HIE婴儿接受TH的不良神经发育结局相关。CrSO2可以为寻求早期识别有严重损伤风险的患者提供信息，这些患者可能从进一步干预中受益。
Background: Neurological outcomes in neonatal hypoxic-ischemic encephalopathy (HIE) continue to be suboptimal despite therapeutic hypothermia (TH). Cerebral near-infrared spectroscopy provides real-time regional oxygen saturation (CrSO2) that may be a marker of adverse MRI findings and neurodevelopmental outcomes.Aim: The aim of this study was to examine the value of CrSO2 monitoring in infants with HIE undergoing TH.Study design and subjects: In this prospective study, CrSO2 was continuously recorded in 21 infants with HIE admitted for TH.Outcome measures: Brain MRI signal abnormalities at 2 weeks were scored in individual brain region and classified as none/mild, moderate and severe. 13 infants completed Bayley Scales of Infant Development (BSID) testing at 18-24 months.Results: Between 24 and 36 h of life, there was a significant increase in odds of having moderate-severe brain MRI abnormalities with higher absolute CrSO2 values. Per 10% increase in absolute CrSO2, the odds ratio for moderate-severe brain MRI abnormalities was greatest at 30 h (OR 3.78; confidence intervals (CI): 1.23-11.6, p = 0.011). CrSO2 increased more rapidly in infants with greater injury seen on MRI (0.20/h for MRI scores 0/1, by 0.48/h for MRI score 2, and by 0.68/h for MRI score 3, p = 0.05). At 30 h, absolute CrSO2 correlated significantly with abnormal MRI findings in basal ganglia (92% vs. 78%, p = 0.001), white matter (88% vs. 76%, p = 0.01), posterior limb of internal capsule.(92% vs. 78%, p = 0.001), and brain stem (94% vs. 80%, p = 0.03) but not with cortical injury (86% vs. 80%, p = 0.17). Higher CrSO2 beyond 24 h correlated with greater odds of worse BSID scores.Conclusions: Increasing CrSO2 is associated with moderate-severe brain injury as assessed by MRI. Higher absolute CrSO2 values during TH correlates with subcortical injury on MRI and poor neurodevelopmental outcomes in infants with HIE undergoing TH. CrSO2 can inform providers seeking early identification of patients at risk of worse injury who may benefit from further intervention.