Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic-ischaemic encephalopathy: a nested substudy of a randomised controlled trial.
Assessment of brain tissue injury after moderate hypothermia in neonates with hypoxic-ischaemic encephalopathy: a nested substudy of a randomised controlled trial.
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DOI：
10.1016/s1474-4422(09)70295-9
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发表时间：
2010-01
期刊：
影响因子：
48
通讯作者：
Azzopardi, Denis
中科院分区：
文献类型：
--
作者：
Rutherford, Mary;Ramenghi, Luca A.;Edwards, A. David;Brocklehurst, Peter;Halliday, Henry;Levene, Malcolm;Strohm, Brenda;Thoresen, Marianne;Whitelaw, Andrew;Azzopardi, Denis
中度低温治疗新生儿缺氧缺血性脑病可能会改善18个月大的存活率和神经功能结局，尽管在这个年龄进行完整的神经功能评估是困难的。为了更准确地确定治疗性低温对新生儿脑损伤的影响，我们评估了参与全身低温治疗新生儿脑病（TOBY）试验的婴儿的MRI扫描脑损伤。在TOBY试验中，缺氧缺血性脑病根据振幅积分EEG的变化进行临床分级，婴儿通过中央电话随机分配到有或无冷却的重症监护室。以围生期因素为协变量，通过logistic回归分析评估低温或常温与脑病变之间的关系，并计算校正比值比（OR）。TOBY试验已注册，编号ISRCTN 89547571。在2002年至2006年期间，在TOBY试验中招募了325名婴儿。研究人员对131名婴儿的图像进行了分析。治疗性低温与基底节或丘脑病变（OR 0·36，95% CI 0·15-0·84; p=0·02）、白色物质（0·30，0·12-0·77; p=0·01）和内囊后肢异常（0·38，0·17-0·85; p=0·02）减少相关。与未冷却的婴儿相比，冷却的婴儿具有较少的可预测后期神经运动异常的扫描（0.41，0.18 - 0.91; p= 0.03），并且更可能具有正常扫描（2.81，1.13 - 6.93; p= 0.03）。MRI预测18个月龄死亡或残疾的准确性在冷却组为0.84（0.74 - 0.94），在非冷却组为0.81（0.71 - 0.91）。治疗性低温降低新生儿缺氧缺血性脑病的脑组织损伤。MRI对随后神经功能损害的预测价值不受治疗性低温的影响。英国医学研究理事会;英国卫生部。
Moderate hypothermia in neonates with hypoxic–ischaemic encephalopathy might improve survival and neurological outcomes at up to 18 months of age, although complete neurological assessment at this age is difficult. To ascertain more precisely the effect of therapeutic hypothermia on neonatal cerebral injury, we assessed cerebral lesions on MRI scans of infants who participated in the Total Body Hypothermia for Neonatal Encephalopathy (TOBY) trial. In the TOBY trial hypoxic–ischaemic encephalopathy was graded clinically according to the changes seen on amplitude integrated EEG, and infants were randomly assigned to intensive care with or without cooling by central telephone randomisation. The relation between allocation to hypothermia or normothermia and cerebral lesions was assessed by logistic regression with perinatal factors as covariates, and adjusted odds ratios (ORs) were calculated. The TOBY trial is registered, number ISRCTN 89547571. 325 infants were recruited in the TOBY trial between 2002 and 2006. Images were available for analysis from 131 infants. Therapeutic hypothermia was associated with a reduction in lesions in the basal ganglia or thalamus (OR 0·36, 95% CI 0·15–0·84; p=0·02), white matter (0·30, 0·12–0·77; p=0·01), and abnormal posterior limb of the internal capsule (0·38, 0·17–0·85; p=0·02). Compared with non-cooled infants, cooled infants had fewer scans that were predictive of later neuromotor abnormalities (0·41, 0·18–0·91; p=0·03) and were more likely to have normal scans (2·81, 1·13–6·93; p=0·03). The accuracy of prediction by MRI of death or disability to 18 months of age was 0·84 (0·74–0·94) in the cooled group and 0·81 (0·71–0·91) in the non-cooled group. Therapeutic hypothermia decreases brain tissue injury in infants with hypoxic–ischaemic encephalopathy. The predictive value of MRI for subsequent neurological impairment is not affected by therapeutic hypothermia. UK Medical Research Council; UK Department of Health.