患缺血缺氧性脑病足月新生儿整幅脑电图上的睡眠觉醒周期

Objective. The objective of this amplitude-integrated electroencephalography (aEEG) study was to evaluate the influence of perinatal hypoxia-ischemia on sleep-wake cycling (SWC) in term newborns and assess whether characteristics of SWC are of predictive value for neurodevelopmental outcome. Methods. From a consecutive series of newborns born during a 10-year period, the aEEG tracings of 171 term newborns with hypoxic-ischemic encephalopathy were assessed for the presence, time of onset, and quality of SWC. SWC patterns were categorized with regard to the background pattern on which they presented, as normal or abnormal SWC. Results. SWC was seen in 95.4%of the surviving newborns and in 8.1%of those who died. The median time intervals from birth to onset of SWC were significantly different in newborns with hypoxicischemic encephalopathy grades I, II, and III (7, 33, and 62 hours, respectively). Newborns with seizure discharges developed SWC with a delay of 30.5 hours. Good outcome was associated with earlier onset of SWC and normal SWC pattern. The difference in the median Griffiths’developmental quotients in newborns who started SWC before after 36 hours was 8.5 points. The goodpoor neurodevelopmental outcome was predicted correctly by the onset of SWC beforeafter 36 hours in 82%of newborns. Conclusions. The presence, time of onset, and quality of SWC reflected the severity of the hypoxicischemic insult to which newborns were exposed. The time of onset of SWC has a predictive value for neurodevelopmental outcome.

早产新生儿颅内超声和MRI检查结果的比较及其与学龄期神经发育的关系

Aim: To examine the correlation between neonatal cranial ultrasound and school age magnetic resonance imaging (MRI) and neurodevelopmental outcome. Methods: In a prospective 2 year cohort study, 221 children (gestational age ≤ 32 weeks and/or birth weight ≤ 1500 g) participated at a median age of 8.1 years (inclusion percentage 78% ). Conventional MRI, IQ (subtests of the WISC), and motor performance (Movement Assessment Battery for Children) at school age were primary outcome measurements. Results: Overall, there was poor correspondence between ultrasound group classifications and MRI group classifications, except for the severe group (over 70% agreement). There was only a 1% chance of the children with a normal cranial ultrasound having a major lesion on MRI. Mean IQ (standard deviation) was significantly lower in children with major ultrasound or MRI lesions, but was also lower in children with minor lesions on MRI compared to children with a normal MRI (91 ± 16, 100 ± 13, 104 ± 13 for major lesions, minor lesions, and normal MRI, respectively). Median total impairment score (TIS) was significantly higher in children with major lesions on ultrasound or MRI as well as in children with minor lesions on MRI (TIS 4.0 and 6.25 for normal and minor lesions on MRI, respectively; p < 0.0001). Conclusions: A normal neonatal cranial ultrasound excluded a severe lesion on MRI in 99% of cases. MRI correlated more strongly with mean IQ and median TIS than ultrasound. Subtle white matter lesions are better detected with MRI which could explain the stronger correlation of MRI with IQ and motor performance.

围生期窒息24h内的振幅整合脑电图背景图形的恢复

Objective: To assess the time course of recovery of severely abnormal initial amplitude integrated electroencephalographic (aEEG) patterns (flat trace (FT), c ontinuous low voltage (CLV), or burst suppression (BS)) in full term asphyxiated neonates, in relation to other neurophysiological and neuroimaging findings and neurodevelopmental outcome. Methods: A total of 190 aEEGs of full term infants were reviewed. The neonates were admitted within 6 hours of birth to the neonata l intensive care unit because of perinatal asphyxia, and aEEG recording was star ted immediately. In all, 160 infants were included; 65 of these had an initial F T or CLV pattern and 25 an initial BS pattern. Neurodevelopmental outcome was as sessed using a full neurological examination and the Griffiths’mental developme ntal scale. Results: In the FT/CLV group, the background pattern recovered to co ntinuous normal voltage within 24 hours in six of the 65 infants (9%). All six infants survived the neonatal period; one had a severe disability, and five were normal at follow up. In the BS group, the background pattern improved to normal voltage in 12 of the 25 infants (48%) within 24 hours. Of these infants, one d ied, five survived withmoderate to severe disability, two with mild disability, and four were normal. The patients who did not recover within 24 hours either di ed in the neonatal period or survived with a severe disability. Conclusion: In t his study there was a small group of infants who presented with a severely abnor mal aEEG background pattern within six hours of birth, but who achieved recovery to a continuous normal background pattern within the first 24 hours. Sixty one percent of these infants survived without, or with a mild, disability.