Role of amplitude-integrated electroencephalography in neonates with cardiovascular compromise

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE Journal of critical care Pub Date : 2010-06-01 DOI:10.1016/j.jcrc.2008.11.008

Walid I. El-Naggar MD , Matthew Keyzers RRT , Patrick J. McNamara MD, MRCPCH

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引用次数: 12

Abstract

Background

Neonates with congenital heart disease (CHD) and persistent pulmonary hypertension of the newborn (PPHN) represent conditions with increased risk of abnormal neurologic outcome. The role of aEEG in disorders where cerebral perfusion/oxygenation is affected by cardiac or pulmonary disease is unknown.

Objective

The aim of the study was to characterize amplitude-integrated electroencephalography (aEEG) traces in nonasphyxiated neonates with cardiorespiratory compromise secondary to PPHN or CHD.

Design/Methods

Three hundred sixty-three aEEG records (June 2004-November 2006) were reviewed to identify neonates with a diagnosis of isolated CHD or PPHN. Clinical course, critical interventions, and neurodiagnostic investigation data were collected. The aEEG traces were reviewed by a single blinded expert and classified according to background activity (normal, moderate, or severely abnormal) and presence of seizures. The frequency of abnormal aEEG in both groups and its relationship to recognized markers of abnormal neurologic outcome (electrophysiology [EP] testing and neuroimaging [ultrasound (USS), computerized tomography, and magnetic resonance imaging] was studied.

Results

Thirty neonates (PPHN [n = 20], CHD [n = 10]) were reviewed at a mean gestation of 39.2 ± 1.1 weeks and weight of 3375 ± 565g. Neonates with PPHN had lower Apgar scores at 1-minute (P = .02) and were significantly more likely to require inotropic support (P < .001), inhaled nitric oxide (P = .001), or surfactant (P = .01). An abnormal aEEG was found in 15 (50%) babies, but rates did not differ between CHD (n = 6) and PPHN (n = 9). The rates of abnormal composite neurologic outcome (2/3 of abnormal EP, neuroimaging, or neurologic examination) were significantly higher in neonates with abnormal aEEG. An abnormal magnetic resonance imaging was seen in 4 of 5 neonates with abnormal aEEG.

Conclusions

The risk of abnormal aEEG is high in sick neonates with PPHN or complex CHD. Prospective evaluation of the relationship between aEEG recordings in these disorders and acute cardiorespiratory physiology, comprehensive neuroimaging, and long-term patient outcomes is needed.

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波幅整合脑电图在新生儿心血管疾病中的作用

背景:先天性心脏病(CHD)和新生儿持续性肺动脉高压(PPHN)患儿出现异常神经系统预后的风险增加。aEEG在脑灌注/氧合受心脏或肺部疾病影响的疾病中的作用尚不清楚。目的研究非窒息新生儿继发于PPHN或CHD的心肺功能损害的波幅积分脑电图(aEEG)特征。设计/方法对2004年6月至2006年11月期间的363例aEEG记录进行回顾性分析，以确定诊断为孤立性冠心病或PPHN的新生儿。收集临床病程、关键干预措施和神经诊断调查资料。aEEG记录由单盲专家检查，并根据背景活动(正常、中度或严重异常)和癫痫发作的存在进行分类。研究两组患者异常aEEG的频率及其与神经系统异常预后的公认标记物(电生理[EP]测试和神经影像学[超声(USS)、计算机断层扫描和磁共振成像])的关系。结果30例新生儿(PPHN [n = 20]， CHD [n = 10])平均妊娠39.2±1.1周，体重3375±565g。患有PPHN的新生儿在1分钟时Apgar评分较低(P = 0.02)，并且更有可能需要肌力支持(P <.001)、吸入一氧化氮(P = .001)或表面活性剂(P = .01)。aEEG异常患儿15例(50%)，CHD患儿6例(n = 6)， PPHN患儿9例(n = 9)，复合神经功能异常发生率(EP、神经影像学或神经检查异常的2/3)明显高于aEEG异常患儿。5例aEEG异常新生儿中有4例磁共振成像异常。结论PPHN或复杂冠心病患儿aEEG异常的危险性高。需要对这些疾病的aEEG记录与急性心肺生理学、综合神经影像学和长期患者预后之间的关系进行前瞻性评估。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.