Background

Hypoxic-ischemic encephalopathy (HIE) occurs in 1-4:1000 live births. Although neonates with moderate-severe HIE have been studied over several decades, newborns with mild HIE remain understudied, including seizure occurrence, electroencephalography (EEG) characteristics, and outcome.

Methods

We conducted a retrospective cohort study of neonates ≥35 weeks of gestation with mild HIE who underwent therapeutic hypothermia to correlate the early EEG background pattern with clinical course and outcomes.

Results

Of the included 29 neonates, 10 infants had a moderately to severely abnormal EEG background and 19 had either a normal or a mildly abnormal background. Those with moderately to severely abnormal background also had more multiorgan dysfunction (90% vs 42%, P = 0.02) and a higher incidence of subdural and intraventricular hemorrhages (80% vs 26%, P = 0.02). The overall seizure incidence was 20.7% and was significantly higher in newborns with more severely abnormal background compared to neonates with less abnormal background (50% vs 5%; P = 0.01; relative risk, 9.5; 95% confidence interval, 1.28-70.6). Seizure onset was between 11 and 63 hours of life. Regardless of the EEG background pattern, seizures were brief with an overall low seizure burden. None of the newborns with normal or mildly abnormal background had a new onset of seizures after 24 hours of recording or developed epilepsy during infancy.

Conclusions

In neonates with mild HIE, early moderately to severely abnormal EEG background is common and strongly associated with an increased risk for seizures.

中文翻译：

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轻度 HIE 婴儿接受低温治疗的早期脑电图背景与结果之间的关联

背景

缺氧缺血性脑病 (HIE) 发生在 1-4:1000 活产儿中。尽管已经对中重度 HIE 新生儿进行了数十年的研究，但对轻度 HIE 新生儿的研究仍然不足，包括癫痫发作、脑电图 (EEG) 特征和结果。

方法

我们对妊娠 ≥ 35 周的轻度 HIE 新生儿进行了一项回顾性队列研究，这些新生儿接受过低温治疗，以将早期脑电图背景模式与临床过程和结果相关联。

结果

在纳入的 29 名新生儿中，10 名婴儿的 EEG 背景为中度至重度异常，19 名婴儿的脑电图背景正常或轻度异常。具有中度至重度异常背景的患者也有更多的多器官功能障碍（90% 对 42%，P  = 0.02）和更高的硬膜下和脑室内出血发生率（80% 对 26%，P  = 0.02）。总体癫痫发作率为 20.7%，异常背景较严重的新生儿明显高于异常背景较轻的新生儿（50% 对 5%；P = 0.01; 相对风险，9.5；95% 置信区间，1.28-70.6)。癫痫发作在出生后 11 至 63 小时之间。无论脑电图背景模式如何，癫痫发作都很短暂，总体癫痫发作负担很低。背景正常或轻度异常的新生儿均未在记录 24 小时后出现新的癫痫发作或在婴儿期发展为癫痫。

结论

在患有轻度 HIE 的新生儿中，早期中度至重度异常脑电图背景很常见，并且与癫痫发作风险增加密切相关。