Seizure burden and neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy
Seizure burden and neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy
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DOI：
10.1111/dmcn.13215
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发表时间：
2016-12-01
影响因子：
3.8
通讯作者：
Boylan, Geraldine B.
中科院分区：
文献类型：
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作者：
Kharoshankaya, Liudmila;Stevenson, Nathan J.;Boylan, Geraldine B.
目的探讨新生儿缺氧缺血性脑病（hypoxic-ischemic encephalopathy，HIE）患儿电图癫痫发作与远期预后的关系。方法选取2003 - 2006年（预低温期）和2009 - 2012年（低温期）在科克大学妇产医院出生的HIE足月新生儿，进行观察性研究。所有患者均接受早期连续脑电图监测。对所有电描记癫痫发作进行注释。计算总癫痫发作负担和每小时癫痫发作负担。结果在24至48个月时，使用Bayley婴幼儿发育量表（第三版）或Griffiths精神发育量表对存活新生儿（正常/异常）进行评估;脑性麻痹或癫痫的诊断也被认为是异常结果。结果连续脑电图记录的中位数为57.1小时（四分位距33.5-80.5h）; 29/47例（62%）有电图癫痫发作，25/47例（53%）有异常结局。癫痫发作本身的存在与异常结果无关（p=0.126）;然而，异常结果的几率增加了9倍以上（比值比[OR] 9.56; 95%置信区间[95% CI] 2.43-37.67），如果新生儿的总癫痫发作负荷超过40分钟，（p=0.001），8倍（OR：8.00; 95% CI：2.06-31.07），如果新生儿的最大每小时癫痫发作负荷超过13分钟/小时（p=0.003）。控制电描记HIE分级或治疗与低温并没有改变方向的癫痫发作负担和outcome.InterpretationIn HIE，高电描记癫痫发作负担与异常结果显着相关，独立于HIE的严重程度或治疗与低温。
AimTo examine the relationship between electrographic seizures and long-term outcome in neonates with hypoxic-ischemic encephalopathy (HIE).MethodFull-term neonates with HIE born in Cork University Maternity Hospital from 2003 to 2006 (pre-hypothermia era) and 2009 to 2012 (hypothermia era) were included in this observational study. All had early continuous electroencephalography monitoring. All electrographic seizures were annotated. The total seizure burden and hourly seizure burden were calculated. Outcome (normal/abnormal) was assessed at 24 to 48 months in surviving neonates using either the Bayley Scales of Infant and Toddler Development, Third Edition or the Griffiths Mental Development Scales; a diagnosis of cerebral palsy or epilepsy was also considered an abnormal outcome.ResultsContinuous electroencephalography was recorded for a median of 57.1 hours (interquartile range 33.5-80.5h) in 47 neonates (31 males, 16 females); 29 out of 47 (62%) had electrographic seizures and 25 out of 47 (53%) had an abnormal outcome. The presence of seizures per se was not associated with abnormal outcome (p=0.126); however, the odds of an abnormal outcome increased over ninefold (odds ratio [OR] 9.56; 95% confidence interval [95% CI] 2.43-37.67) if a neonate had a total seizure burden of more than 40 minutes (p=0.001), and eightfold (OR: 8.00; 95% CI: 2.06-31.07) if a neonate had a maximum hourly seizure burden of more than 13 minutes per hour (p=0.003). Controlling for electrographic HIE grade or treatment with hypothermia did not change the direction of the relationship between seizure burden and outcome.InterpretationIn HIE, a high electrographic seizure burden is significantly associated with abnormal outcome, independent of HIE severity or treatment with hypothermia.