Therapeutic Hypothermia in Neonatal Hypoxic Ischemic Encephalopathy: Electrographic Seizures and Magnetic Resonance Imaging Evidence of Injury
Therapeutic Hypothermia in Neonatal Hypoxic Ischemic Encephalopathy: Electrographic Seizures and Magnetic Resonance Imaging Evidence of Injury
复制标题
DOI：
10.1016/j.jpeds.2013.01.041
复制
发表时间：
2013-08-01
影响因子：
5.1
通讯作者：
Mathur, Amit
中科院分区：
文献类型：
--
作者：
Srinivasakumar, Preethi;Zempel, John;Mathur, Amit
目的探讨新生儿缺氧缺血性脑病（HIE）患儿在接受或不接受治疗性低温治疗后的脑电图癫痫负荷，并根据HIE严重程度和磁共振成像（MRI）评估的损伤严重程度对结果进行分层。计算癫痫发作负荷（以秒为单位），并对脑部MRI扫描进行定量评分。资料以单因素方差分析、t检验及χ 2检验进行分析。结果69例中、重度HIE患儿中，51例接受亚低温治疗，18例未接受亚低温治疗。治疗性低温组的视频脑电图监测平均持续时间较长（72 +/- 34小时vs 48 +/- 34小时; P = 0.01）。通过MRI评估，治疗性低温组在控制损伤后的电图癫痫负荷（log单位）较低（2.9 +/- 0.6 vs 6.2 +/- 0.9; P = .003）。中度缺氧缺血性脑病的新生儿癫痫发作负荷减少（P = 0.0001），但重度缺氧缺血性脑病的新生儿癫痫发作负荷没有减少（P = 0.80）。在MRI评估的损伤新生儿中，轻度（P = .0004）和中度（P = .02）损伤的癫痫发作负荷较低，但在重度损伤的新生儿中无此差异（P = .90）。这种影响在中度HIE的婴儿视频脑电图中检测到，但在重度HIE的婴儿中没有检测到。当通过MRI评估损伤分层时，治疗性低温与轻度和中度损伤婴儿的癫痫发作负担减少相关，但与重度损伤婴儿无关。
Objective To evaluate the electrographic seizure burden in neonates with hypoxic ischemic encephalopathy (HIE) treated with or without therapeutic hypothermia and stratified results by severity of HIE and severity of injury as assessed by magnetic resonance imaging (MRI).Study design Between 2007 and 2011, video-electroencephalography (EEG) monitoring was initiated in neonates with moderate to severe HIE. Seizure burden (in seconds) was calculated, and brain MRI scans were quantitatively scored. Data were analyzed by ANOVA, the Student t test, and the chi(2) test.Results Sixty-nine neonates with moderate or severe HIE were prospectively enrolled, including 51 who received therapeutic hypothermia and 18 who did not. The mean duration of video-EEG monitoring was longer in the therapeutic hypothermia group (72 +/- 34 hours vs 48 +/- 34 hours; P = .01). The therapeutic hypothermia group had a lower electrographic seizure burden (log units) after controlling for injury, as assessed by MRI (2.9 +/- 0.6 vs 6.2 +/- 0.9; P = .003). A reduction in seizure burden was seen in neonates with moderate HIE (P = .0001), but not in those with severe HIE (P = .80). Among neonates with injury assessed by MRI, seizure burden was lower in those with mild (P = .0004) and moderate (P = .02) injury, but not in those with severe injury (P = .90).Conclusion Therapeutic hypothermia was associated with reduced electrographic seizure burden in neonatal HIE. This effect was detected on video-EEG in infants with moderate HIE, but not in those with severe HIE. When stratified by injury as assessed by MRI, therapeutic hypothermia was associated with a reduced seizure burden in infants with mild and moderate injury, but not in those with severe injury.