دانلود رایگان مقاله انگلیسی الکتروانسفالوگرافی مجتمع آماری برای تشخیص زودهنگام آسیب مغزی در نوزادان - الزویر 2018

Objective To study perioperative amplitude-integrated electroencephalography (aEEG) as an early marker for new brain injury in neonates requiring cardiac surgery for critical congenital heart disease (CHD). Study design This retrospective observational cohort study investigated 76 neonates with critical CHD who underwent neonatal surgery. Perioperative aEEG recordings were evaluated for background pattern (BGP), sleepwake cycling (SWC), and ictal discharges. Spontaneous activity transient (SAT) rate, inter-SAT interval (ISI), and percentage of time with an amplitude <5 V were calculated. Routinely obtained preoperative and postoperative magnetic resonance imaging of the brain were reviewed for brain injury (moderate-severe white matter injury, stroke, intraparenchymal hemorrhage, or cerebral sinovenous thrombosis). Results Preoperatively, none of the neonates showed an abnormal BGP (burst suppression or worse) or ictal discharges. Postoperatively, abnormal BGP was seen in 18 neonates (24%; 95% CI, 14%-33%) and ictal discharges was seen in 13 neonates (17%; 95% CI, 8%-26%). Abnormal BGP and ictal discharges were more frequent in neonates with new postoperative brain injury (P = .08 and .01, respectively). Abnormal brain activity (ie, abnormal BGP or ictal discharges) was the single risk factor associated with new postoperative brain injury in multivariable logistic regression analysis (OR, 4.0; 95% CI, 1.3-12.3; P = .02). Postoperative SAT rate, ISI, or time <5 V were not associated with new brain injury. Conclusion Abnormal brain activity is an early, bedside marker of new brain injury in neonates undergoing cardiac surgery. Not only ictal discharges, but also abnormal BGP, should be considered a clear sign of underlying brain pathology.

Discussion

Our study demonstrates that abnormal brain activity (ie, abnormal BGP or ictal discharges) in the postoperative period is predictive of new brain injury in neonates with critical CHD undergoing cardiac surgery with the use of CPB. We showed that in one subgroup, abnormal brain activity in the early postnatal period is also associated with preoperative brain injury. The results of this study show that aEEG can contribute to earlier identification of neonates at the greatest risk for developing brain injury. Quantitative EEG measures (ie, SAT rate, ISI, and time <5 V) were not predictive of brain injury in either the perioperative period or the postnatal period. Our study shows that not only ictal discharges, but also abnormal BGP, should be considered as a clear sign of underlying brain pathology. There are 2 possible explanations for the relationship between abnormal BGP and brain injury. First, as with ictal discharges, an abnormal BGP might show the acute response of brain activity to brain injury. Second, an abnormal BGP also might be a sign of underlying (overall) brain immaturity and vulnerability (ie, brain activity is more easily depressed in response to drugs and events, and the brain requires more time to recover to normal brain activity), with the more immature brain also being at increased risk for developing brain injury.4 This hypothesis is supported by the study of Mulkey et al showing early postnatal abnormal BGP (DNV and worse) to be related to brain atrophy.15 In contrast to our study, however, Mulkey et al did not find a relationship between early postnatal abnormal BGP and brain injury, which might be due to defining DNV as an abnormal BGP.