Cerebral function monitoring during the first week of life in extremely small low birthweight (ESLBW) infants

In order to evaluate the usefulness of early continuous EEG-monitoring in very preterm neonates, recordings with a Cerebral Function Monitor (CFM) were made prospectively in 31 ESLBW infants with birthweights below 901 grams, during their first week of life. The CFM background activity was, as expected from EEG studies, dominated by a suppression-burst pattern in 94% of the infants. Some infants had periods with more continuous EEG activity or suppression-burst changing into continuous. Patterns similar to sleep-wake cycling (SWC) were identified in infants with gestational ages as low as 24 weeks. The level of the CFM-background activity was mainly influenced by the presence and severity of intracranial hemorrhage (ICH), but also by medications such as phenobarbital. Epileptiform activity (EPA) was only found in infants with ICH, and was identified in 75% of these infants. Of the infants with EPA, 87% had periods with subclinical EPA, although 47% had both clinical and subclinical seizures. The presence of more continuous activity and SWC were indicators of a favourable outcome, whereas electrocerebral inactivity predicted an unfavorable outcome. The prognostic estimates of mortality and neurologic outcome were similar for early CFM recording (positive predictive value 69-100%) and cranial ultrasound scan (positive predictive value 71-100%). The monitoring of cerebral electrical activity also provided immediate and clinically useful information during the intensive care of these ESLBW infants. Further studies on the causal relation between EPA and the development of ICH should be performed before definite conclusions can be drawn concerning any preventive effect from anticonvulsive treatment of clinical/subclinical seizures.     

Early serial EEG in hypoxic ischaemic encephalopathy.

OBJECTIVES: To perform early serial EEGs in infants with hypoxic ischaemic encephalopathy (HIE) and compare the findings with neurodevelopmental outcome. METHODS: Nine full-term neonates with HIE had simultaneous video-EEG polygraphic studies within 8 h of birth. The EEG was repeated at 12-24 h intervals. All surviving infants had a neurodevelopmental assessment at 1 year. RESULTS: Two infants had a normal or mildly abnormal EEG within 8 h of birth and neurodevelopmental outcome was normal. Seven infants had severely depressed background activity in the first 8 h of life. In 3 infants the EEG activity recovered within 12-24 h showing continuous activity with no or only minor abnormalities. All these infants had a normal outcome. The remaining 4 infants, who also had an initially inactive recording, subsequently developed severe background abnormalities. At follow-up, two infants had died and the remainder developed major neurological sequelae. CONCLUSIONS: Early EEG is an excellent prognostic indicator for a favourable outcome if normal within the first 8 h of life and for a poor outcome if the background activity continues to be inactive or grossly abnormal beyond 8-12 h of life. However, an inactive or very depressed EEG within the first 8 h of life can be associated with good outcome if the EEG activity recovers within 12 h.     

Hypoxic-ischemic spinal cord injury following perinatal asphyxia

The role of spinal cord injury in the pathogenesis of abnormal motor signs (depressed tone and reflexes) following severe perinatal hypoxia-ischemia was prospectively evaluated by clinical, electrophysiological, and neuropathological examinations in 18 asphyxiated neonates. All infants had an abnormal mental status (lethargy or coma), and seizures were present in 12. Neuromuscular examinations revealed hypotonia or flaccidity and hyporeflexia or areflexia in all infants. Neuropathological examinations of the cerebrum and spinal cord were conducted in the 12 neonates who expired. Cerebral pathological findings included cortical neuronal necrosis in 10 of 12 and subcortical white matter injury in 5 of 12. All infants with coma or seizures displayed diffuse cortical injury, but no injury conformed to a parasagittal "watershed" distribution. Spinal cord gray matter displayed prominent ischemic necrosis in 5 patients who were typically flaccid and areflexic. Electromyographic examinations of all 6 survivors were abnormal, consistent with recent injury to the lower motor neuron above the level of the dorsal root ganglion. We conclude that ischemic injury to anterior horn cells within spinal cord gray matter is relatively common among hypotonic-hyporeflexic neonates following severe perinatal hypoxia-ischemia. Although the acute neurological syndrome of neonatal asphyxia is often overshadowed by prominent cerebral signs such as coma and seizures, the motor abnormalities may be partially attributed to concurrent spinal cord injury.     

Progressive posthemorrhagic hydrocephalus leads to changes of amplitude-integrated EEG activity in preterm infants

Aim Intraventricular hemorrhage (IVH) is the most common cause of brain lesions in preterm infants. Among infants with IVH about 35% develop posthemorrhagic hydrocephalus (PPH) which may lead to secondary injury. Therapeutic interventions to reduce the increased intracranial pressure are invasive and carry a high risk of complications. Amplitude-integrated EEG (aEEG) allows continuous neurophysiological surveillance and may help in defining the optimal timing for intervention in infants with progressive PHH. In this report we show, for the first time, a change in aEEG activity in two preterm infants with PHH.Methods Cerebral activity was continuously monitored by aEEG provided by the Cerebral Function Monitor (Lectromed, UK) in two preterm infants with PPH.Results With increasing ventricular width, aEEG showed an increased discontinuity without distinguishable sleep-wake cycling in both infants. One infant showed an abrupt onset of a nearly isoelectric pattern without any change in clinical condition. Clinical signs of increased intracranial pressure developed 6–12 h later in both children. In one patient, aEEG activity returned to normal after successful shunting and reduction of intracranial pressure.Conclusion Continuous neurophysiological monitoring by aEEG may be of value in the diagnostic and therapeutic management of preterm infants with progressive PHH.     

EEG diagnoses of neonatal seizures: clinical correlations and outcome

Electroencephalographic seizures were evaluated in 112 neonates. The first portion of the study involved 80 neonates with clinically identified abnormal movements, 8 of whom (10%) had electroencephalographic evidence of seizures coincident with this activity. Patients with abnormal movements (90%) had no concurrent electrical seizures. In the second part of the study, 40 infants who had electrical seizures were investigated. Eight of these infants had been identified during the first part of the study. Two-thirds of the patients (25) were premature. Sixteen patients (40%) died; 90% had brain lesions documented by computed tomography and/or postmortem study. Cerebral infarction and intraventricular hemorrhage were the most common lesions. One-third of the survivors (8 of 24 patients) were normal at a mean age of 3 years, while two-thirds had significant neurologic and developmental abnormalities. Neonatal seizures often are subtle, not associated with observable clinical expression, and associated with adverse development. Electroencephalographic confirmation is important in the evaluation of neonatal seizures.     

Intracranial hemorrhage in the full-term neonate and young infant: correlation of the location and outcome

The cranial computed tomography (CT) and outcome for 13 full-term neonates and 12 young infants with intracranial hemorrhage (ICH) were studied. The full-term neonates had perinatal asphyxia or neurological signs such as seizures. All infants were breast-fed and showed bleeding diathesis. In the full-term neonates there was a high incidence of intraventricular hemorrhage (IVH) and hemorrhage around the falx. The location of the hemorrhage on CT and brain pathology suggested that the original site of IVH might be the choroid plexus vessels in the lateral ventricle or in the subependymal layer. On the other hand, the sites of ICH in infants were multifocal compared with those in full-term neonates. Subdural hemorrhage (SDH) was seen more frequently and IVH less frequently in infants than in full-term neonates. The cases with SDH frequently showed accompanying cerebral infarction followed by porencephaly. Thus, SDH with cerebral low density on CT may predict a poor prognosis.     

Development of epilepsy in newborns with moderate hypoxic-ischemic encephalopathy and neonatal seizures

Background: Hypoxic-ischemic encephalopathy (HIE) is one of the most frequent causes of neonatal death or neurological handicaps such as cerebral palsy, mental delay, and epilepsy. Moreover, an acute consequence of HIE are neonatal seizures which can cause an additional brain damage. The neurodevelopmental outcome is known in the mild or severe cases of HIE, but in the moderate conditions the predictivity results, to date, unsatisfying. Objective: The purpose of this prospective study was to appraise the development of post-neonatal epilepsy in a cohort of term infants with moderate HIE and neonatal seizures. Methods: This study considered all newborns admitted to Neonatal Intensive Care Unit of the University of Parma between January 2000 and December 2002 for perinatal asphyxia, then followed by Neonatal Neurology Service. In all patients, neonatal variables such as type of delivery, birth weight, gestational age, Apgar scores, the need for resuscitation and assisted ventilation soon after birth, and arterial-blood pH were analyzed. Results: Ninety-two newborns were enrolled in the study because of perinatal asphyxia. Of these, 27 subjects developed mild HIE, 25 moderate, and five severe HIE. Neonatal seizures were present in 13 subjects with moderate HIE and in all newborns with severe HIE. At the last follow-up, only three infants belonging to patients with severe HIE developed epilepsy. Conclusion: Moderate HIE seems not to be related to post-neonatal epilepsy either if associated or not with neonatal seizures.     

新生儿缺氧缺血性脑病的疗效观察(186例回顾性分析)

目的总结分析我科3年来新生儿缺氧缺血性脑病(HIE)的系统治疗方法及相应近期疗效和远期预后,探讨改善预后的措施。方法对186例HIE患儿在各个阶段进行全面系统治疗,对临床资料和随访结果进行回顾性分析。结果186例HIE中足月儿149例(80.1％),早产儿37例(19.9％)。病死率7.5％(重度HIE20.5％,中度5.1％,轻度0)。随访109例,后遗症发生率16.5％(重度HIE60.7％,中度6.1％,轻度0)。早产儿HIE者中度预后不良占37.0％,重度60.7％。结论重度和早产儿HIE预后较差。针对不同阶段病情特点给予综合治疗,可显著改善患儿预后。     

A novel approach to the study of hypoxia-ischemia-induced clinical and subclinical seizures in the neonatal rat

Perinatal hypoxic-ischemic encephalopathy (HIE) is a major cause of acute mortality and chronic neurologic morbidity in infants and children. HIE is the most common cause of neonatal seizures, and seizure activity in neonates can be clinical, with both EEG and behavioral symptoms, subclinical with only EEG activity, or just behavioral. The accurate detection of these different seizure manifestations and the extent to which they differ in their effects on the neonatal brain continues to be a concern in neonatal medicine. Most experimental studies of the interaction between hypoxia-ischemia (HI) and seizures have utilized a chemical induction of seizures, which may be less clinically relevant. Here, we expanded our model of unilateral cerebral HI in the immature rat to include video EEG and electromyographic recording before, during and after HI in term-equivalent postnatal-day-12 rats. We observed that immature rats display both clinical and subclinical seizures during the period of HI, and that the total number of seizures and time to first seizure correlate with the extent of tissue damage. We also tested the feasibility of developing an automated seizure detection algorithm for the unbiased detection and characterization of the different types of seizure activity observed in this model.     

Noninvasive continuous monitoring of cerebral oxygenation periictally using near-infrared spectroscopy: a preliminary report

PURPOSE: To report on the use of near-infrared spectroscopy (NIRS) to examine the changes in cerebral oxygenation in the periictal period in patients with seizures. METHODS: Cerebral hemoglobin oxygen availability was monitored continuously and noninvasively with NIRS in three patients (one in the pediatric intensive care unit (ICU) and two in epilepsy-monitoring units) in conjunction with continuous EEG monitoring. Ictal events were recorded and compared with the pre-, intra-, and postictal periods for cerebral oxygen availability, as defined by oxygenated hemoglobin (HbO2), deoxygenated hemoglobin (Hb), and the redox state of cytochrome oxidase (cytox). RESULTS: Several important preliminary observations were made by using this technology. First, a preictal increase in cerebral oxygenation began between 1 and 2 h and >10 h before the ictal event. Second, despite adequate perfusion, based on an observed increased HbO2, reduction in cytox indicates a perfusion-metabolism mismatch during seizure activity. Third, continued seizure activity and even isolated ictal events were associated with decreased cerebral oxygen availability. Fourth, differences in cerebral oxygen availability were noted between different types of seizures (e.g., electrographic seizures were accompanied by rapid reductions in HbO2 and cerebral blood volume without reduction of cytox, whereas electroclinical seizures were characterized by marked increases in HbO2 with or without reduction of cytox). CONCLUSIONS: In this preliminary report on the use of NIRS for patients with seizures, we believe that NIRS allows continuous and noninvasive monitoring of changes in cerebral oxygenation periictally, thereby permitting investigations into the pathophysiology of seizures and the exploration of the potential of cerebral oximetry as a tool for seizure localization.     

Seizures after spontaneous supratentorial intracerebral hemorrhage

PURPOSE: To characterize seizures after intracerebral hemorrhage (ICH), evaluating the risk of occurrence and relapse, predisposing factors, and prognostic significance, and to assess the utility of antiepileptic drug (AED) therapy as used in clinical practice. METHODS: The study sample consisted of 761 patients with spontaneous, nonaneurysmal, supratentorial ICH. Seizures were classified as immediate (within 24 h of ICH) and early (within 30 days of ICH). Baseline variables and clinical events were compared in the seizure and nonseizure group by using a multivariate regression model of failure time data. RESULTS: Fifty-seven patients had one or more seizures. The 30-day actuarial risk of a post-ICH seizure was 8.1%. Lobar location and small volume of ICH were independent predictors of immediate seizures. Early seizures were associated with lobar location and neurologic complications, mainly rebleeding. In patients with lobar ICH, the risk of early seizures was reduced by prophylactic AED therapy. Among seizure patients, history of alcohol abuse increased the risk of status epilepticus. Immediate and early seizures were not independent predictors of in-hospital mortality. CONCLUSIONS: Patients with ICH are exposed to a substantial risk of seizures; however, short-term mortality was not affected, and the risk of epilepsy was lower than previously thought. The likelihood of immediate seizures is influenced by factors that are inherent characteristics of ICH, whereas the chance of developing early seizures is influenced not only by certain characteristics of ICH, but also by unpredictable events. A brief period of therapy soon after ICH onset may reduce the risk of early seizures in patients with lobar hemorrhage.     

Primary thalamic and caudate hemorrhage in term neonates presenting with seizures

Two previously well term neonates who presented with seizures are described: one with thalamic hemorrhage and the other with thalamic and caudate hemorrhage. These 2 patients were the only neonates found with thalamic hemorrhage in a review of 54 term infants with intracranial hemorrhage at The Hospital for Sick Children over a 10 year period (1976-1986). Partial seizures occurred at 5 and 7 days after birth and were easily controlled. Prognosis was generally good in these 2 patients, as well as in 4 previously reported patients.     

Implementation of a Neurocritical Care Program: Improved Seizure Detection and Decreased Antiseizure Medication at Discharge in Neonates With Hypoxic-Ischemic Encephalopathy

BackgroundWe report the impact of implementing continuous video electroencephalography monitoring for neonates with hypoxic-ischemic encephalopathy via a protocol in the context of neonatal neuro-critical care program.MethodsNeonates with hypoxic-ischemic encephalopathy were studied retrospectively two years before and after implementing continuous video electroencephalography for 72 hours as a care protocol. Before continuous video electroencephalography, a 60-minute routine electroencephalography was performed at the discretion of the provider. Primary outcome: electrographic seizure detection; secondary outcome: use of maintenance antiseizure medications, discharge antiseizure medications, and cumulative burden for each antiseizure medication defined as total mg/kg during hospital stay.ResultsA total of 157 patients with a median gestation of 40 weeks were analyzed; 103 (66%) underwent therapeutic hypothermia. Baseline and clinical characteristics including disease severity and cooling were similar. Before continuous video-electroencephalography (n = 86), 44 (51.2%) had clinical seizures, of those 35 had available routine electroencephalography; 12 of 35 (34%) had electrographic seizures. None of the infants without clinical seizures showed electrographic seizures. After continuous video-electroencephalography (n = 71), 34 (47.9%) had clinical seizures, of those 18 (53%) had electrographic seizures; five of 37 (14%) of infants with no clinical seizures had electrographic seizures. The introduction of continuous video-electroencephalography significantly increased electrographic seizure detection (P = 0.016). Although there was no significant difference in the initiation and maintenance use of antiseizure medications after continuous video-electroencephalography, fewer infants were discharged on any antiseizure medication (P = 0.008). Also, the mean phenobarbital burden reduced (P = 0.04), without increase in other antiseizure medications use or burden.ConclusionUse of continuous video-electroencephalography as part of the neonatal neuro-critical care program was associated with improved electrographic seizure detection, decreased phenobarbital burden, and antiseizure medication use at discharge.     

Electrographic seizures in neonates correlate with poor neurodevelopmental outcome

OBJECTIVE: To quantify the number, duration, and intensity of electrographic seizures (ESz) in neonates and to compare the outcome of neonates with ESz with those who were at risk but did not have ESz recorded. METHODS: The EEG and outcome data were reviewed from 68 infants who met at-risk criteria for neonatal seizures and underwent prolonged continuous EEG monitoring. Forty infants had ESz. The control group contained 28 infants monitored for at least 18 hours and found not to have ESz. Outcomes for both groups were evaluated using hospital and follow-up clinic records and a standardized telephone interview. RESULTS: The etiology of ESz included asphyxia (n = 23), stroke (n = 7), and other (n = 10, intraparenchymal, subdural, and subarachnoid bleeding; meningitis; sepsis; hyponatremia; and unknown). The cumulative recorded ESz duration was 8 minutes to 30 hours. Forty-three percent of infants with ESz spent 38 minutes to 32 hours in electrographic status. Despite doses of 40 mg/kg of phenobarbital and 20 mg/kg of phenytoin, 30% of infants continued to have ESz. Ten infants with ESz and one without died from causes related to neurologic instability. The occurrence of ESz was correlated with microcephaly (p = 0.04), severe cerebral palsy (CP) (p = 0.03), and failure to thrive (p = 0. 03). In the subgroup of infants with asphyxia, those with ESz were more likely to die of neurologic causes (p = 0.02) and have microcephaly (p = 0.05) or severe CP (p = 0.04). Additionally, those with the greatest number of ESz were more likely to have these severe outcomes. CONCLUSION: The authors' data indicate an association between the amount of electrographic seizure activity and subsequent mortality and morbidity in at-risk infants in general and in infants with perinatal asphyxia. Only with more effective treatment of neonatal electrographic seizures can their potential contribution to poor neurodevelopmental outcome, independent of degree of insult, be ascertained.     

The temporal evolution of electrographic seizure burden in neonatal hypoxic ischemic encephalopathy

Purpose: Hypoxic ischemic encephalopathy (HIE) accounts for 60% of all neonatal seizures. There is emerging evidence that seizures cause additional injury to the developing brain that has sustained hypoxic ischemic injury. Temporal evolution of clinical seizure burden in HIE has been characterized, with maximum clinical seizure burden (the period of maximum seizure activity) being observed between 12 and 24 h of age. The purpose of our study was to investigate the distribution of electrographic seizure burden (the accumulated duration of seizures over a defined time period), following the initial hypoxic ischemic insult. Methods: Fifteen full‐term newborns with HIE and seizures, and a minimum of 48 h of continuous video–electroencephalography (EEG), were included in this retrospective study. Medical records of the infants were reviewed and details of clinical seizures and antiepileptic drugs were recorded. The time of maximum seizure burden was defined as the midpoint of an hour‐long window, shifted in time by 1 s across the full EEG recording, which contained the maximum duration of seizures. The degree of temporal evolution of seizure burden within this period was tested. Temporal evolution was further analyzed by segmenting the time series into two periods; the time between the first recorded seizure and the maximum seizure burden (T₁), and the time between the maximum seizure burden and the last recorded seizure (T₂). Seizure burden, duration, and number of seizures per hour were analyzed within each time period. Key Findings: EEG was commenced at a median of 14 h of age. Maximum electrographic seizure burden was reached at a median age of 22.7 h. Time from first recorded seizure to maximum seizure burden (T₁) was significantly shorter than time from maximum seizure burden to last recorded seizure (T₂) (p‐value = 0.01). Median seizure burden during T₁ was significantly higher than during T₂ (p‐value = 0.007). There is temporal evolution of electrographic seizure burden in full‐term newborns with HIE. There is a short period of high seizure burden (T₁) followed by a longer period of lower seizure burden (T₂). Significance: Understanding the temporal evolution of seizure burden in HIE contributes further to our understanding of neonatal seizures, helps identify an optimal therapeutic window for seizure treatment, and provides a benchmark against which to measure the efficacy of new and innovative forms of neuroprotection and antiepileptic medication.     

Seizures and epilepsy in patients with a spontaneous intracerebral haematoma

BACKGROUND: Seizures occur more frequently in patients with an intracerebral haematoma (ICH) than in those with a cerebral infarct. However, the risk factors for seizures in association with an ICH are less well known. PURPOSE: The characteristics of medically treated patients with spontaneous ICHs, who developed seizures, were retrospectively compared to those who did not. PATIENTS: Fourteen patients were admitted to the Stroke Unit during 2004-2006 for seizures related to an ICH. Their characteristics were compared to those of 51 patients admitted during 2002-2004 for an ICH without subsequent seizures. RESULTS: Early-onset seizures, occurring within 48 h of stroke onset, were observed in six patients with ICH related epileptic spells (42.9%). Late-onset ones occurred in eight patients, on average 8 months after the ICH. A focal onset of the seizures was documented in 75.7% of cases. Status epilepticus was observed in 21.4% of the patients. The seizures recurred in only 28.6% of the patients. Lobar haematomas were present in 78.6% of the seizure group, compared to 21.4% in the control group (P=0.008). In the former group a frontal lobe involvement was present in 57.1% compared to 9.8% in the latter group (P<0.001). On the post-ictal EEG, intermittent rhythmic delta activities were observed in 28.6% and periodic lateralized epileptic discharges in 21.4% of the seizure patients. CONCLUSIONS: Seizures are more prone to occur in patients with frontal lobar haematomas. EEG can be helpful for the diagnosis of seizures in approximately 50% of the cases.     

Prediction of short-term neurological outcome in full-term neonates with hypoxic-ischaemic encephalopathy based on combined use of electroencephalogram and neuro-imaging

BACKGROUND: In infants with hypoxic-ischaemic encephalopathy (HIE), prediction of the prognosis is based on clinical, neuro-imaging and neurophysiological parameters. METHODS: EEG, cranial ultrasound, MRI and follow-up findings of 23 infants (GA 35-42 weeks) with HIE were studied retrospectively to assess 1) the contribution of ultrasound, MRI and EEG in predicting outcome, 2) the accuracy of ultrasound as compared to MRI, and 3) whether patterns of brain damage and EEG findings are associated. RESULTS: An abnormal EEG background pattern was highly predictive of adverse outcome [positive predictive value (PPV) 0.88]. If combined with diffuse white and deep and/or cortical grey matter changes on ultrasound or MRI, the PPV increased to 1.00. Abnormal neuro-imaging findings were also highly predictive of adverse outcome. Abnormal signal intensity in the posterior limb of the internal capsule, and diffuse cortical grey matter damage were associated with adverse outcome. MRI showed deep grey matter changes more frequently than ultrasound. Severely abnormal neuro-imaging findings were always associated with abnormal EEG background pattern. CONCLUSIONS: Both early EEG and neuro-imaging findings are predictive of outcome in infants with HIE. The predictive value of EEG is strengthened by neuro-imaging.     

Antithrombin replacement in neonates: is there any indication?

INTRODUCTION: Activation of the coagulation system and severe acquired antithrombin (AT) deficiency are common and prognostically important findings in sick and preterm neonates. It has been hypothesised that treatment of the acquired AT deficiency with AT concentrate may improve the outcome of conditions such as the neonatal respiratory distress syndrome (RDS), intracranial hemorrhage (ICH) and sepsis. MATERIALS AND METHODS: We performed a systematic review of randomised controlled trials (RCTs) of AT replacement therapy in newborn infants. RESULTS: Two full-length trial reports were found. Both were placebo-controlled. The first RCT examined the effects of AT therapy in 122 preterm infants with RDS. Administration of AT prolonged rather than shortened the duration of mechanical ventilation and oxygen therapy. The second RCT determined whether AT replacement decreased the incidence of ICH in 60 preterm infants who were born before 30 weeks of gestation. No beneficial effect on ICH was found. CONCLUSIONS: Preterm infants with RDS do not benefit from therapy with AT concentrate and may be harmed. There is also little evidence that the administration of AT reduces the risk of ICH. The role of AT replacement during neonatal sepsis remains uncertain.     

促血小板生成素对预测脑瘫高危儿的意义

目的探讨缺氧缺血性脑病(hypoxia-ischem ia encephalopathy,H IE)胎儿和H IE新生儿血清中促血小板生成素(Thrombopoietin,TPO)水平与脑损伤的关系,为脑瘫(cerebral palsy,CP)高危儿人群进行早期干预提供监测手段。方法收集23例H IE胎儿和34例H IE新生儿血清以及25例正常胎儿和30例正常新生儿血清,34例H IE新生儿包括11例轻度H IE,8例中度H IE和15例重度H IE。采用双抗体夹心ABC-ELISA法检测H IE胎儿组和轻、中、重H IE新生儿组血清中TPO的水平,并与正常胎儿组和正常新生儿组比较。结果H IE胎儿组和H IE新生儿组TPO分别高于正常胎儿组和正常新生儿组(分别P<0.01,P<0.01),重度H IE组TPO低于轻度H IE组(P<0.05)。结论血清TPO水平与H IE所致脑损伤严重程度有关。脐血TPO检测可为脑瘫高危儿人群进行早期干预提供监测手段。     

Comparative clinical study of preterm and full-term newborn neonatal seizures

OBJECTIVE: To compare the characteristics of neonatal seizures between preterm and full-term infants in intensive care unit. METHOD: A prospective study was developed with 104 high-risk newborn, 30 preterm and 74 full-term infants, with clinical seizures. The dependent variable was gestational age. Statistical analyses: Fisher's exact test, odds-ratio and Mann Whitney U test. RESULTS: There were significant differences (p<0.05): i) Premature neonates develop neonatal seizures later, probably related to the etiologies of the seizures; ii) Etiologically, there is a predominance of peri-intraventricular hemorrhage in preterm and of asphyxia in full term neonates; iii) Clonic seizures are most frequent in preterm and subtle seizures in full term neonates. CONCLUSION: Although the study had a clinical basis, it was possible to identify differences when the dependent variable was gestational age.