同步视频脑电图监测下双导振幅整合脑电图诊断新生儿惊厥的价值

目的 探讨双导振幅整合脑电图(amplitude-integrated electroencephalogram,aEEG)(C3-C4/T3-T4)附加对应的双导原始脑电图(electroencephalogram,EEG)诊断新生儿惊厥的价值及局限性. 方法 2011年1月至7月,对66例入住复旦大学附属儿科医院的临床有惊厥发作或可疑惊厥发作的新生儿,进行床旁视频脑电图(video electroencephalogram,VEEG)监测,时间≥3h.通过Galileo NT PMS软件将原始EEG转化为3种形式aEEG,即单导aEEG(C3-C4)、单导aEEG(C3-C4)附加原始EEG、双导aEEG(C3-C4/T3-T4)附加原始EEG.EEG和aEEG分开判读,VEEG需标记电发作(≥10 s)起始放电灶及放电持续时间,aEEG只进行电发作标记.以VEEG作为标准,采用Spearman相关分析计算aEEG与VEEG识别电发作的相关性.以敏感性、特异性、阳性预测值、阴性预测值评估aEEG诊断新生儿惊厥的价值及局限性. 结果 共62例新生儿的脑电图纳入分析.(1)电发作:VEEG发现39例患儿电发作≥1次,其中8例发生癫痫持续状态,31例非癫痫持续状态惊厥.31例非癫痫持续状态惊厥VEEG发现电发作活动累计352次,其中79.3％(279次)以颞中央区为起始放电灶.(2)电发作次数识别敏感性:8例癫痫持续状态,aEEG与VEEG诊断结果一致;VEEG监测到352次非癫痫持续状态电发作,单导aEEG、单导aEEG附加原始EEG和双导aEEG附加原始EEG识别电发作敏感性分别为49.1％(173/352)、54.5％ (192/352)和81.2％ (286/352),各组识别电发作数和VEEG记录的放电灶记录总数均相关(ρ=0.790、0.907和0.953,P均＜0.01).(3)惊厥患儿识别敏感性(≥1次电发作):单导aEEG、单导aEEG附加原始EEG和双导aEEG附加原始EEG识别惊厥患儿的敏感性分别为66.7％ (26/39,95％ CI:0.62～0.81)、74.4％ (29/39,95％CI:0.78～0.96)和89.7％ (35/39,95％CI:0.89～1.00). 结论 结合VEEG,有助于aEEG诊断新生儿惊厥,aEEG添加T3-T4导联及原始EEG可显著提高其对惊厥电发作及惊厥患儿的识别敏感性.     

振幅整合脑电图对新生儿惊厥的评价意义

目的 研究振幅整合脑电图(amplitude integrated electroencephalogram,aEEG)对新生儿惊厥的评价意义.方法 对2008年7月至2009年7月于北京大学第一医院新生儿病房收治的32例新生儿惊厥患儿在同一天进行aEEG与视频脑电图(video electroencephalogram,VEEG)监测,分析aEEG脑电振幅波谱带、脑电背景节律及原始脑电信号,并与VEEG结果 进行对比.结果 有12例患儿在VEEG监测过程中有临床惊厥发作,在aEEG中均监测到,监测敏感性达100%;VEEG表现为发作间期放电的20例,aEEG监测的敏感性87%,特异性100%,阳性预测值100%,阴性预测值80%,但aEEG不能区分发作期放电或者发作间期放电.VEEG监测中背景活动异常的13例患儿,aEEG监测的敏感性100%,特异性83%,阳性预测值76%,阴性预测值100%.32例患儿在VEEG监测中均可见发作期或发作间期痫样放电,而aEEG的原始脑电亦能监测到,有3例患儿在aEEG整合后振幅波谱带中未监测到放电,但在原始脑电中能监测到.结论 aEEG对新生儿惊厥监测的敏感性和特异性比较理想,可以作为一种简单、可靠的新生儿惊厥的初步筛查方法.

Abstract：

Objective To study the evaluative values of amplitude integrated electroencephalogram (aEEG) in screening neonatal seizures.Methods The aEEG and video electroencephalogram (VEEG) on 32 patients with seizures hospitalized in Peking University First Hospital was conducted on the same day.The parameters of aEEG including the integrated spectra band,background rhythm and primitive electro signal were analyzed and compared with VEEG.Results Seizures presented clinically by 12 cases were detected by VEEG,and their electric discharges were detected by aEEG.The sensitivity of aEEG was 100%.VEEG showed electric discharges during intermediate stage in twenty cases and thus the seventeen of this group were detected by aEEG with its sensitivity of 87% and 100% in the specificity.The positive and negative predictive values of aEEG were 80% and 100%,respectively.But aEEG could not discriminate the attack stage or intermediate stage electric discharges.The abnormal background activity was detected by VEEG in 13 cases and the sensitivity of aEEG was 100% and the specificity was 83%.The positive and negative predictive value by aEEG were 76% and 100% respectively.The electric discharges of 32 cases were detected by VEEG whenever they were in attack stage or intermediate stage.All electric discharges could be detected through primitive electro signal by aEEG.The electric discharges in 3 cases were not detected by integrated spectra band from aEEG,but were detected by primitive electro signal from aEEG.Conclusions The sensitivity and specificity in the screening of neonatal seizures by aEEG is useful and could be applied clinically as a simple and safe screening method for recognizing neonatal seizures.     

脑电图对新生儿缺氧缺血性脑病预后的诊断评估

目的　对缺氧缺血性脑病 ( HIE)患儿进行随访观察 ,以评价脑电图 ( EEG)在判断 HIE预后中的价值。　方法　对 62例 HIE中存活的 57例患儿进行体格检查及智力测试 ,对异常者行CT、EEG检查 ,评价其临床后遗症与新生儿期 EEG的关系。　结果　 62例 HIE患儿新生儿期 EEG显示电静息 3例 ,2例死亡 ,1例偏瘫 ;爆发抑制 4例 ,2例死亡 ,1例脑瘫 ,1例未见明显异常 ;低电压 5例 ,1例死亡 ,1例脑瘫 ,1例 IQ低下 ,2例未见异常 ;9例节律性放电者 ,1例出现癫。EEG重度异常后遗症发生率为 2 9% ,轻度异常其发生率为 3 %。　结论　EEG异常情况与临床 HIE程度呈正相关 ,且重度异常者其后遗症发生率显著高于轻度异常者。新生儿 EEG可作为 HIE早期判断预后的一种有效、方便的检查手段。     

近红外光谱技术产时监测宫内缺氧性脑损伤的价值

目的 探讨近红外光谱技术产时监测宫内缺氧性脑损伤的价值,为临床评价脑损伤提供客观、量化依据.方法 63例宫内窘迫胎儿根据出生后是否合并新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)分为HIE组(34例)及无HIE组(29例);35例无宫内窘迫的正常新生儿为对照组.应用近红外光谱技术测定3组新生儿胎头拨露时和生后5 min时脑组织氧饱和度(regional oxygen saturation,rSO2),受试者工作特性曲线评价脑rSO2对HIE的诊断价值.结果 HIE组患儿产程中胎头拨露及生后5 min时脑rSO2分别为(36.6±5.0)%和(52.0±4.2)%,均明显低于对照组[分别为(45.9±4.6)%和(59.6±4.4)%]及宫内窘迫但无HIE组[分别为(44.1±3.1)%和(57.6±3.5)%](P<0.01).对照组、宫内窘迫但无HIE组、HIE组产程中胎头拨露时脑rSO2与脐动脉血气pH值间均呈正相关性(r=0.463,P<0.01;r=0.619,P<0.01;r=0.688,P<0.01),与脐动脉血气血氧饱和度间亦呈正相关性(r=0.709,P<0.01;r=0.736,P<0.01;r=0.516,P<0.01).以胎头拨露时脑rSO2<39.5%为界值,rSO2评判宫内窘迫新生儿发生HIE的敏感性及特异性分别为67%及93%;以生后5 min脑rSO2<53.5%为界值,rSO2评判宫内窘迫新生儿发生HIE的敏感性及特异性分别为70%及86%.结论 近红外光谱技术测定脑rSO2能客观评价宫内窘迫新生儿脑氧合状态,可提示新生儿HIE的存在.     

视频脑电图对早产儿脑损伤诊断价值的研究

目的研究视频脑电图(VEEG)对早产儿早期脑损伤的诊断价值,并探讨与头颅B超(US)、核磁共振(MRI)以及神经元烯醇化酶(NSE)的诊断相关性。方法选择2001年12月至2003年12月入山东大学齐鲁医院的早产儿48例，并根据临床表现、Apgar评分以及1周后的MRI检查结果将48例早产儿分为无脑损伤组(21例)和有脑损伤组(27例)。同时在生后48h及1周进行血清NSE测定。VEEG和US在生后3d以内及7~10d各分别检查1次。结果(1)无脑损伤组在生后48h VEEG有4例异常，异常率19.0%，生后7d的VEEG有2例异常，异常率为9.5%；有脑损伤组48h、7d的VEEG的异常率分别为77.8%、88.8%。7d时VEEG的诊断准确度为89.6%，敏感性为88.9%，特异性为90.5%。US的诊断准确性为95.8%，敏感性为92.6%，特异性为100%。两种方法在诊断早产儿脑损伤方面无显著性差异(2)无脑损伤组与脑损伤组48h NSE值存在显著性差异。但7d时的NSE值两组并无显著性差异(t=1.85,P>0.05)。(3)VEEG的异常与母亲有妊娠合并症(胆汁淤积症、重度妊高征等以及围产因素：羊水Ⅲ度污染、脐带绕颈等)有相关关系。结论早期动态检测VEEG不仅可以早期发现脑损伤，而且对预后有很好的预测。在诊断早产儿脑损伤方面与US、MRI有诊断相关性。VEEG与US的诊断准确率无显著性差异。NSE在生后3d以内明显升高提示脑损伤，与VEEG的结果有诊断一致性。而在1周后NSE值很快下降，故其不能作为随访的指标。连续监测VEEG对判断早产儿脑损伤的时间和程度有很好的评价。     

缺氧缺血性脑病新生儿血浆脑利钠肽的动态变化及其临床意义

目的动态观察缺氧缺血性脑病(hypoxia-ischemic encephalopathy,HIE)新生儿血浆脑利钠肽(brain natriuretic peptide,BNP)变化规律及其与血钠、新生儿行为神经测定的关系。方法124例HIE患儿,血钠低于130mmol/L者36例为低血钠组,88例为血钠正常组;另选取非HIE、足月、体重正常、血钠正常者38例为对照组。比较三组患儿出生第3、7、14天血浆BNP水平。比较低血钠组和血钠正常组新生儿行为神经测定(neonatal behavioral neurological assessment,NBNA)结果及跟踪观察52周的发育商数(developmental quotient,DQ),并分析血浆BNP与血清钠、NBNA评分的相关性。结果生后第3天,124例HIE患儿血浆BNP为(0.612±0.11)ng/ml,明显高于对照组(t=2.296,P<0.05);低血钠组明显高于血钠正常组(q=7.70,P=0.000)及对照组(q=9.04,P=0.000)。生后3、7、14d时,血钠正常组NBNA评分均高于低血钠组,低血钠组患儿NBNA评分从生后第3天至第14天逐渐升高(P均<0.01)。在28周以前(含28周),低血钠组与血钠正常组的大运动、精细运动、适应能力、语言和社会交往5个方面比较差异均有统计学意义(P均<0.05)。在52周时,两组大运动、精细运动、语言和社会交往4个方面差异有统计学意义(P均<0.05)。在出生后3、7、14d时,低血钠组血浆BNP水平与血清钠浓度呈负相关(r分别为-0.762、-0.671、-0.735,P均<0.01);血清钠与NBNA评分呈正相关(r分别为0.695、0.570、0.538,P均<0.01)。结论BNP可能参与和导致了HIE患儿的低钠血症,并直接和经过低钠介导在HIE病理过程中发挥重要作用。动态监测血浆BNP浓度可以作为判断病情、评价疗效和预测预后的指标。     

新生儿缺氧缺血性脑病低钠血症与血浆脑利钠肽相关性研究

目的探讨新生儿缺氧缺血性脑病(HIE)低钠血症与血浆脑利钠肽(BNP)相关性；HIE病理过程中的BNP及低钠血症生理和病理作用机制。 方法枣阳市第一人民医院于2002年10月至2004年10月，动态观察22例低钠血症HIE患儿3日龄、7日龄和2周时血浆BNP和血钠水平，并进行相关性分析。同时与血钠正常的52例HIE患儿及血钠正常非HIE患儿(对照组)进行比较。 结果3日龄HIE患儿BNP显著高于对照组(P<001)；7日龄时，血钠正常的HIE患儿与对照组之间已无明显统计学差异，而低钠血症HIE组明显高于血钠正常HIE组(P<001)；低钠血症组的三个时间段BNP之间差异均具有显著性(P<001)；低钠血症组各时间段的血钠浓度呈递减，依次比较差异有显著性。低钠血症HIE组与血钠正常HIE组相应时间段行为神经(NBNA)测定比较差异具有显著性(P<001)；低钠血症组的HIE患儿在三个时间段NBNA比较差异具有显著性(P<005)。低钠血症组BNP水平与血钠离子在各时间段具有负相关性。 结论BNP参与和导致了HIE低钠血症，并直接和经过低钠介导在HIE病理过程中起重要作用。     

全身运动质量评估的不安运动在新生儿脑病随访中的应用

目的:探讨应用全身运动质量评估(简称GMs)的不安运动对新生儿脑病神经发育结局的早期预测。方法:将2010年7月至2011年4月在江西省儿儿童医院新生儿科随访,在GMs不安运动阶段(足月后9～22周)至少记录了一次GMs的新生儿脑病患儿为对象,随访至半岁以上采用婴幼儿发育量表或神经系统检查等评估神经发育结局。结果:GMs的不安运动评估结果正常者组的预后正常率明显高于评估结果异常组(P<0.01)有统计学意义。结论:GMS评估中的不安运动能够早期预测新生儿脑病患儿的神经发育结局。     

新生儿缺氧缺血性脑病398例临床分析

目的总结新生儿缺氧缺血性脑病(HIE)的临床特点及预后情况,为提高该病诊治水平总结经验。方法对398例新生儿缺氧缺血性脑病患儿住院资料进行分析总结。结果所有病例均有异常围产史,急性宫内窘迫、窒息、催产素助娩、脐带、胎位和羊水异常以及胎头吸引助娩等异常围产史为HIE常见原因;患儿在生后3d内行血尿素氮、谷丙转氨酶、谷草转氨酶、乳酸脱氢酶、α羟丁酸脱氢酶、肌酸激酶、肌酸激酶同功酶检测,中度、重度与轻度比较,差异均有统计学意义(P0.01);对305例系统治疗患儿随访观察至12个月,总预后不良率7.54%。结论加强和规范孕期保健、提高产科技术、规范新生儿窒息抢救是预防HIE防治重点;中、重度HIE多合并心、肝、肾等多脏器损害,强调综合治疗;头颅CT对HIE病情及预后判断有重要作用,早期诊断应侧重于临床表现;综合治疗、早期干预、科学连续、坚持全程治疗可明显改善中、重度HIE预后,减少神经系统后遗症。     

中西医结合及早期康复训练治疗新生儿缺氧缺血性脑病疗效观察

目的观察中西医结合及早期康复训练治疗新生儿缺氧缺血性脑病临床疗效。方法 2012年1月至2015年1月庆阳市中医医院儿科收治住院的中、重度HIE患儿152例,随机分为观察组和对照组各76例。对照组早期均进行吸氧、镇静、利尿、降颅压、有效控制惊厥等对症支持治疗,病情稳定后给予注射用脑蛋白水解物和单唾液酸四己糖神经节苷脂注射液静脉滴注。观察组在对照组治疗的基础上运用中医辨病辨证依据加用中药治疗并进行早期康复训练。日龄3d、14d、28d做神经行为评分(NBNA),评价两组患儿治疗前后NBNA评分;分别于3、6、9、12、18个月时作智能发育测定;治疗结束时观察比较两组临床疗效。结果观察组总有效率为92.1%(70/76),高于对照组78.9%(60/76),差异有统计学意义(P0.05)。两组治疗后NBNA评分均较治疗前明显改善,差异有统计学意义(P0.05);观察组治疗后NBNA评分均高于对照组,差异有统计学意义(P0.01)。两组治疗后发育商评分均较治疗前明显改善,差异有统计学意义(P0.01),观察组发育商评分改善较对照组更显著,差异有统计学意义(P0.01)。结论中西医结合及早期康复训练治疗新生儿缺氧缺血性脑病疗效确切。     

Relationship between electroencephalography and magnetic resonance imaging findings after hypoxic-ischemic encephalopathy at term

Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal morbidity and mortality. Electroencephalography (EEG) and brain magnetic resonance imaging (MRI) are frequently performed in these infants, but the prognostic value of the combined use of EEG and MRI needs additional exploration. The purpose of this study was to investigate, in neonates with HIE, the role of early EEG and conventional MRI in the prediction of infants at risk for persistent encephalopathy at 18 months of age. Thirty-four term infants with HIE were enrolled in this prospective study. EEG was recorded within the first 72 hours after birth and a brain MRI scan was done between 1 and 4 weeks of age. Denver Developmental Screening Test II was performed at 6, 12, and 18 months of age. Three infants (9%) had mild HIE, 21 infants (62%) had moderate HIE, and 10 infants (29%) had severe HIE. The EEG background was normal, moderately, severely, and extremely discontinuous in eight (24%), three (9%), sixteen (47%), and seven (20%) neonates, respectively. EEG background activities correlated significantly with HIE severity (p = 0.0001). MRI findings significantly correlated with EEG background (p = 0.001). Normal MRI scans and minimal basal ganglia lesions were always associated with normal EEG background. Patients with severe basal ganglia and thalamic lesions in MRI (n = 2) had extreme discontinuous EEG background. For the prediction of poor outcomes, abnormal EEG background activity had a sensitivity (Sn) = 100%, a specificity (Sp) = 100%, positive predictive value (PPV) = 100%, and negative predictive value (NPV) = 100%, whereas values of abnormal MRI scans were Sn of 100%, Sp = 43%, PPV = 82%, and NPV=100%. EEG background activity is the best element to predict abnormal outcomes. Severe basal ganglia and thalamic injuries on MRI scans are associated with poor outcomes. Otherwise, MRI does not contribute to the prediction of outcomes at 18 months of age.     

Comparison between creatine kinase brain isoenzyme (CKBB) activity and Sarnat score for prediction of adverse outcome following perinatal asphyxia

AIM: To assess whether plasma creatine kinase brain isoenzyme (CKBB) levels or Sarnat scores are more accurate for prediction of poor neurological outcome in babies with suspected birth asphyxia. METHODS: In a retrospective study of 97 babies CKBB levels were compared to the presence of severe hypoxic ischaemic encephalopathy (HIE) as a predictive test for these outcomes: developmental delay, cerebral palsy, visual problems, deafness or death from perinatal asphyxia. The tests were compared using positive predictive values (PPV) and likelihood ratios (LR) with confidence intervals (CI). RESULTS: 3 babies had died from perinatal asphyxia and 14 survivors were found to have neurological or developmental problems. CKBB was elevated in babies with severe HIE (p = 0.0004). A receiver operator characteristic (ROC) curve showed the optimal discriminating value for CKBB to be 21 IU/L but the CKBB was a poor predictive test. For prediction of adverse outcome: CKBB > 21 sensitivity 76%, specificity 40%, PPV 21% and LR 1.3 (95% CI 0.8-1.7). Severe HIE sensitivity 53%, specificity 95%, PPV 69% and LR 10.6 (95% CI 3.8-29.2). CONCLUSION: CKBB is elevated following birth asphyxia but is a poor predictor of adverse neurological outcome.     

外源性神经生长因子早期干预对减轻重度窒息新生儿脑损伤程度的临床研究

探讨外源性神经生长因子（NGF）早期干预对重度窒息新生儿脑损伤程度及血清髓鞘碱性蛋白（MBP）和酸性钙结合蛋白S-100的影响。方法　将2007年1月至2009年10月广州市儿童医院新生儿重症监护室（NICU）收治的52例重度窒息复苏后的新生儿随机分为2组：常规对照组26例,即在对症支持处理的基础上使用脑蛋白水解物（脑活素）和胞二磷胆碱治疗;治疗组26例,在常规对照组的基础上尽早（生后24 h内）应用鼠NGF治疗。另取同期无窒息正常足月新生儿10例作为正常对照。观察与比较两组重度缺氧缺血性脑病（HIE）的发生率以及治疗前后血清MBP、S-100的变化并进行行为神经评分测定。结果　治疗组重度HIE的发生率与常规对照组比较,差异无统计学意义（23.08% vs 38.46%,χ2 = 1.4444,P > 0.05）;两组间病死率比较,差异亦无统计学意义（3.85% vs 7.69%,χ2 = 0.0000,P > 0.05）。正常足月儿生后早期血清MBP为（1.68±0.85） μg/L,S-100为（1.291±0.66） μg/L。重度窒息复苏后新生儿血清MBP、S-100均显著升高。治疗组与常规对照组比较,在生后3 d及生后7～8 d时,血清MBP和S-100差异均具统计学意义,前者明显低于后者。生后7～8 d 和14～16 d的行为神经评分 < 35分者所占百分比,治疗组（分别为40.00%和20.00%）与常规对照组（分别为70.83%和50.00%）比较,差异均具有统计学意义（χ2 = 4.7055,P < 0.05;χ2 = 4.8640,P < 0.05）。结论　对重度窒息的新生儿,在对症支持治疗基础上尽早使用NGF能显著减轻缺氧缺血性脑损伤程度。     

Postnatal lactate as an early predictor of short-term outcome after intrapartum asphyxia.

OBJECTIVES: To compare the predictive value of pH, base deficit and lactate for the occurrence of moderate-to-severe hypoxic ischaemic encephalopathy (HIE) and systemic complications of asphyxia in term infants with intrapartum asphyxia. STUDY DESIGN: We retrospectively reviewed the records of 61 full-term neonates (> or =37 weeks gestation) suspected of having suffered from a significant degree of intrapartum asphyxia from a period of January 1997 to December 2001.The clinical signs of HIE, if any, were categorized using Sarnat and Sarnat classification as mild (stage 1), moderate (stage 2) or severe (stage 3). Base deficit, pH and plasma lactate levels were measured from indwelling arterial catheters within 1 hour after birth and thereafter alongwith every blood gas measurement. The results were correlated with the subsequent presence or absence of moderate-to-severe HIE by computing receiver operating characteristic curves. RESULTS: The initial lactate levels were significantly higher (p=0.001) in neonates with moderate-to-severe HIE (mean+/-SD=11.09+/-4.6) as compared to those with mild or no HIE (mean+/-SD=7.1+/-4.7). Also, the lactate levels took longer to normalize in these babies. A plasma lactate concentration >7.5+/-mmol/l was associated with moderate-or-severe HIE with a sensitivity of 94% and specificity of 67%. The sensitivity and negative predictive value of lactate was greater than that of the pH or base deficit. CONCLUSIONS: The highest recorded lactate level in the first hour of life and serial measurements of lactate are important predictors of moderate-to-severe HIE.     

Risk factors of the vertical transmission of human papilloma virus in newborns from singleton pregnancy – preliminary report

Objectives.?Hypoxic-ischemic cerebral injury due to perinatal asphyxia is an important cause of neonatal mortality and morbidity. To predict who will survive or die due to this disorder still remains obscure. The aim of this study is to evaluate the predictive value of myocardial involvement in the assessment of mortality for the neonates with hypoxic-ischemic encephalopathy (HIE).

Patients and methods.?The study included 34 term newborns fulfilling the diagnostic criteria for HIE and staged according to Sarnat and Sarnat classification. To assess the myocardial involvement, electrocardiogram (ECG) and echocardiogram (Echo) were performed in the first 24–48 h of life. In addition, serum Troponin I and creatine kinase-myocardial band (CK-MB) were measured at delivery and postnatal day 3.

Results.?Of the 34 cases, 19 (55.9%) were stage in 1, 9 were in (26.4%) stage 2 and 6 (17.6%) were in stage 3 HIE. Nine (26.4%) patients died of the disease. Thirteen patients (38.2%) showed ECG findings related to perinatal asphyxia. Only one patient had mild Echo changes. Higher Troponin I level was a significant predictor of mortality, whereas CK-MB did not show any significant predicting value. Troponin I test showed 33% sensitivity and 80% specificity in predicting mortality. In addition, the sensitivity and specificity of ECG as a predictor of mortality were 77 and 76%, respectively.

Conclusion.?This study highlights the significance of monitoring cardiac functions in newborns with HIE. ECG changes and serum Troponin I level at 72 h after birth are likely to have significant predictive value in the assessment of mortality in HIE. Further studies will provide additional data for the long-term prognostic value of cardiac functions in this disorder.     

Mild hypothermia via selective head cooling as neuroprotective therapy in term neonates with perinatal asphyxia: an experience from a single neonatal intensive care unit.

OBJECTIVE: The objective of this study was to determine the efficacy of mild hypothermia via selective head cooling as a neuroprotective therapy in term infants with perinatal asphyxia. STUDY DESIGN: Full-term newborns who had 5 min Apgar scores <6, first arterial blood gas pH<7.10 or BD>15 mEq/l, and with the clinical signs of encephalopathy were enrolled within 6 h after birth. Patients were randomized to receive mild hypothermia treatment via selective head cooling for a total of 72 h or receive routine treatment as a control. Brain hypoxic-ischemic injury was quantified based on the head computed tomographic scan (CT scan) at postnatal age 5-7 days and a Neonatal Behavioral Neurological Assessment (NBNA) score at 7-10 days of life. RESULTS: A total of 58 patients (30 hypothermia, 28 control) completed the study. Hypothermia was well tolerated in this study and attenuated the hypoxic-ischemic brain injury due to perinatal asphyxia. Head CT scan demonstrated moderate to severe hypoxic-ischemic changes in only 4/30 cases from the hypothermic group. In contrast, 18/28 cases in the control group showed moderate to severe hypoxic-ischemic changes (chi (2)=15.97, P<0.01). Brain hypothermia also significantly improved the NBNA score (32+/-2 in the hypothermic group vs 28+/-3 in the control group, P<0.01). CONCLUSIONS: Our results suggest that selective head cooling may be used as a neuroprotective therapy in term neonates with perinatal asphyxia. A long-term follow-up study is needed to further validate the results of this study.     

Nucleated red blood cells count as a prognostic biomarker in predicting the complications of asphyxia in neonates

Objective: Nucleated-red-blood-cells (NRBC) count in umbilical cord of newborns is been suggested as a sign of birth asphyxia. The present study was conducted to explore the value of NRBC count in prognosis of asphyxiated neonates.

Methods: Sixty-three neonates with asphyxia were followed up for two years. Maternal and neonatal information was recorded follow by clinical and laboratory evaluation. NRBC-level was determined per 100 white-blood-cells (WBC). After discharge, follow-up of asphyxiated infants was performed using Denver II test at 6, 12, 18 and 24 months. Neonates were divided into two groups, with favorable and unfavorable outcome based on developmental delay or death.

Results: We observed that NRBC count with more than 11 per 100 WBC, had sensitivity of 85% and specificity of 90% in predicting complications of asphyxia, while in absolute NRBC count with more than 1554, the sensitivity and specificity were 85% and of 87%, respectively. Combination of NRBC?+?HIE (hypoxic ischemic encephalopathy) grade had a high-predictive power for determining the prognosis of asphyxia in neonates.

Conclusion: We demonstrate that NRBC/100 WBC and absolute NRCB count can be used as prognostic marker for neonatal asphyxia, which in combination with the severity of asphyxia could indicate high infant mortality, and complications of asphyxia. Further studies in a larger and multi center setting trail are warranted to investigate the value of NRBC and HIE in asphyxiate term infants.     

Should amplitude-integrated electroencephalography be used to identify infants suitable for hypothermic neuroprotection?

OBJECTIVE: Amplitude-integrated electroencephalography (aEEG) has been used adjunctively to identify infants suitable for hypothermic neuroprotection following severe intrapartum asphyxia. To determine whether an early aEEG predicts short-term adverse outcome in infants with significant hypoxic-ischemic encephalopathy (HIE) evaluated for hypothermic neuroprotection. STUDY DESIGN: The aEEG recordings were obtained within 6 h of birth in infants >or=36 weeks' gestational age during evaluation for possible selective head or whole-body cooling. Recordings were subsequently re-evaluated for both background pattern and voltage abnormalities by a certified reader masked to clinical history and brain-oriented interventions. All infants with moderate or severe HIE evaluated for hypothermic neuroprotection also underwent magnetic resonance imaging (MRI) of the brain at a median postnatal age of 7 days. The predictive value using the aEEG for determining short-term dichotomous outcomes, defined as early death related to HIE, or a characteristic pattern of abnormalities consistent with hypoxic-ischemic injury on the MRI brain scans was assessed. RESULT: Fifty-four infants with moderate or severe HIE were evaluated with aEEG for hypothermic neuroprotection; 34 infants received selective head cooling, 12 infants underwent total body cooling and 8 infants were not cooled. Outcome data, available for 46 of the 54 infants, revealed a poor correlation between the early aEEG and short-term adverse outcomes, with a sensitivity of 54.8% and negative predictive value (NPV) of only 44%. CONCLUSION: Because of the poor NPV of an early aEEG for a short-term adverse outcome, its use as an 'additional selection criterion' for hypothermic neuroprotection may not be appropriate.