Early EEG Findings in Hypoxic-Ischemic Encephalopathy Predict Outcomes at 2 Years
Early EEG Findings in Hypoxic-Ischemic Encephalopathy Predict Outcomes at 2 Years
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DOI：
10.1542/peds.2008-2190
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发表时间：
2009-09-01
期刊：
影响因子：
8
通讯作者：
Connolly, Sean
中科院分区：
文献类型：
--
作者：
Murray, Deirdre M.;Boylan, Geraldine B.;Connolly, Sean
目的：探讨新生儿缺氧缺血性脑病(HIE)后脑电(EEG)的变化规律。方法：对足月新生儿缺氧缺血性脑病(HIE)进行连续、多通道、视频脑电监测，记录时间为产后6h~72h。对出生后6、12、24和48小时的婴儿进行脑电分析，并在24个月时评估神经学结果。结果：44名婴儿完成了神经发育随访。在这些患者中，有20例(45%)结局异常。脑电分级与预后显著相关。脑电异常随着时间的推移而改善，在所有病例中，最早记录的脑电分级最差。6小时龄时预测能力最好(受试者特征曲线下面积：0.958[95%可信区间：0.88~1.04]；P=.000)。6、12或24小时的正常/轻度异常脑电结果对正常结果的阳性预测值为100%，阴性预测值为67%至76%。到了48小时，许多脑电结果都有了显著的改善。这导致异常脑电结果的阳性预测值在48小时内更大(93%)，同时阴性预测值为71%。与异常结局相关的脑电特征有：背景波幅30 mV，发作间期30秒，发作间期30秒，发作间期为48小时，无睡眠-觉醒周期。结论：早期脑电是预测HIE预后的可靠指标。出生后6小时内脑电结果正常或轻度异常与24个月时正常的神经发育结果相关。儿科2009；124：e459-e467
OBJECTIVE: We examined the evolution of electroencephalographic (EEG) changes after hypoxic injury.METHODS: Continuous, multichannel, video-EEG was recorded for term infants with hypoxic-ischemic encephalopathy, from < 6 hours to 72 hours after delivery. One-hour segments at 6, 12, 24, and 48 hours of age of the EEG were analyzed visually, and neurologic outcome was assessed at 24 months.RESULTS: Forty-four infants completed neurodevelopmental follow-up. Of those, 20 (45%) had abnormal outcomes. The EEG grade assigned correlated significantly with outcome. EEG abnormalities improved with time, with the worst EEG grade seen on the earliest recording in all cases. The best predictive ability was seen at 6 hours of age (area under the receiver operator characteristic curve: 0.958 [95% confidence interval: 0.88-1.04]; P = .000). Normal/mildly abnormal EEG results at 6, 12, or 24 hours had 100% positive predictive values for normal outcomes and negative predictive values of 67% to 76%. By 48 hours, many of the EEG findings had improved significantly. This led to the positive predictive value of abnormal EEG results being greater at 48 hours (93%), with a concurrent negative predictive value of 71%. EEG features that were associated with abnormal outcomes were background amplitude of < 30 mu V, interburst interval of > 30 seconds, electrographic seizures, and absence of sleep-wake cycling at 48 hours.CONCLUSIONS: Early EEG is a reliable predictor of outcome in HIE. A normal or mildly abnormal EEG results within 6 hours after birth were associated with normal neurodevelopmental outcomes at 24 months. Pediatrics 2009; 124: e459-e467