Seizures and Magnetic Resonance Imaging-Detected Brain Injury in Newborns Cooled for Hypoxic-Ischemic Encephalopathy

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• 作者：Hannah C. Glass ; MDCM^a ; ^b ; ^{Hannah.Glass@ucsf.edu} ; Kendall B. Nash ; MD^a ; ^b ; Sonia L. Bonifacio ; MD^b ; A. James Barkovich ; MD^a ; ^c ; Donna M. Ferriero ; MD^a ; ^b ; Joseph E. Sullivan ; MD^a ; ^b ; Maria Roberta Cilio ; MD ; PhD^a ; ^d
• 关键词：EEG ; Electroencephalography ; HIE ; Hypoxic-ischemic encephalopathy ; MRI ; Magnetic resonance imaging ; RR ; Relative risk
• 刊名：The Journal of Pediatrics
• 出版年：2011
• 出版时间：November, 2011
• 年：2011
• 卷：159
• 期：5
• 页码：731-735.e1
• 全文大小：129 K

文摘

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Objective

To describe the association between electrographically detected seizures and brain injury evaluated by magnetic resonance imaging in newborns treated with hypothermia.

Study design

A total of 56 newborns treated with hypothermia were monitored using video electroencephalography through cooling and rewarming, and then imaged at a median of 5 days. The electroencephalograms were reviewed for indications of seizure and status epilepticus. Moderate-severe injury detected on magnetic resonance imaging was measured using a classification scheme similar to one predicting abnormal outcome in an analogous population.

Results

Seizures were recorded in 17 newborns (30 % ), 5 with status epilepticus. Moderate-severe injury was more common in newborns with seizures (relative risk, 2.9; 95 % CI, 1.2-4.5; m>Pm> = .02), and was present in all 5 newborns with status epilepticus. Newborns with moderate-severe injury had seizures that were multifocal and of later onset, and they were more likely to experience recurrent seizures after treatment with 20 mg/kg phenobarbital. Newborns with only subclinical seizures were as likely to have injury as those with seizures with a clinical correlate (57 % vs 60 % ).

Conclusion

Seizures represent a risk factor for brain injury in the setting of therapeutic hypothermia, especially in neonates with status epilepticus, multifocal-onset seizures, and a need for multiple medications. However, 40 % of our neonates were spared from brain injury, suggesting that the outcome after seizures is not uniformly poor in children treated with therapeutic hypothermia.