Seizures and Magnetic Resonance Imaging-Detected Brain Injury in Newborns Cooled for Hypoxic-Ischemic Encephalopathy
Seizures and Magnetic Resonance Imaging-Detected Brain Injury in Newborns Cooled for Hypoxic-Ischemic Encephalopathy
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DOI：
10.1016/j.jpeds.2011.07.015
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发表时间：
2011-11-01
影响因子：
5.1
通讯作者：
Cilio, Maria Roberta
中科院分区：
文献类型：
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作者：
Glass, Hannah C.;Nash, Kendall B.;Cilio, Maria Roberta
目的描述脑电图检测癫痫发作和脑损伤的磁共振成像评估新生儿治疗hypothermia.Study design一个共56个新生儿治疗的低温进行了监测，通过冷却和复温视频脑电图，然后在中位数为5天成像之间的关联。对脑电图进行了审查，以确定癫痫发作和癫痫持续状态的指征。中重度损伤检测磁共振成像测量使用分类方案类似于一个预测异常结果在一个类似population.Results癫痫发作记录在17个新生儿（30%），5与癫痫持续状态。中重度损伤在癫痫发作的新生儿中更常见（相对危险度，2.9; 95% CI，1.2-4.5; P = 0.02），并且在所有5例癫痫持续状态的新生儿中均存在。中度至重度损伤的新生儿癫痫发作为多灶性和迟发性，并且在20 mg/kg苯巴比妥治疗后更有可能发生复发性癫痫发作。只有亚临床癫痫发作的新生儿有可能有损伤的癫痫发作的临床correlation.Conclusion（57%vs 60%）癫痫发作是脑损伤的危险因素，在设置治疗性低温，特别是在新生儿癫痫持续状态，多灶性发作，需要多种药物。然而，40%的新生儿免于脑损伤，这表明在接受治疗性低温治疗的儿童中，癫痫发作后的结局并不一致。（J Pediatr 2011;159：731-5）。
Objective To describe the association between electrographically detected seizures and brain injury evaluated by magnetic resonance imaging in newborns treated with hypothermia.Study design A total of 56 newborns treated with hypothermia were monitored using video electroencephalography through cooling and rewarming, and then imaged at a median of 5 days. The electroencephalograms were reviewed for indications of seizure and status epilepticus. Moderate-severe injury detected on magnetic resonance imaging was measured using a classification scheme similar to one predicting abnormal outcome in an analogous population.Results Seizures were recorded in 17 newborns (30%), 5 with status epilepticus. Moderate-severe injury was more common in newborns with seizures (relative risk, 2.9; 95% CI, 1.2-4.5; P = .02), and was present in all 5 newborns with status epilepticus. Newborns with moderate-severe injury had seizures that were multifocal and of later onset, and they were more likely to experience recurrent seizures after treatment with 20 mg/kg phenobarbital. Newborns with only subclinical seizures were as likely to have injury as those with seizures with a clinical correlate (57% vs 60%).Conclusion Seizures represent a risk factor for brain injury in the setting of therapeutic hypothermia, especially in neonates with status epilepticus, multifocal-onset seizures, and a need for multiple medications. However, 40% of our neonates were spared from brain injury, suggesting that the outcome after seizures is not uniformly poor in children treated with therapeutic hypothermia. (J Pediatr 2011;159:731-5).