Clinical Application Of Amplitude-integrated Electroencephalography And Cerebral Magnetic Resonance Imaging In Term Newborns At Risk Of Brain Damage

Part oneAssessment of the Application Value of Amplitude-Integrated Electroencephalography in Term Newborns at Risk of Brain DamageObjective:To explore the value of amplitude-integrated EEG (aEEG) in term infants who were at risk of brain damage.Methods:Between November2011and February2013, term newborns who were admitted in Children’Hospital of Fudan University because of suspected brain damage had been monitored with aEEG. The duration of record was4hours or above. The value of aEEG in variety of diseases was analyzed.Results:Recordings from160newborns were retrospectively analyzed. The diseases were classified into6categories:brain damage and hemorrhages, infections, lung and heart diseases, metabolic disorders, congenital malformation and seizures.(1) The detection rate of abnormal background in these infants was19.4%, including mildly abnormal in15cases, severely abnormal in16cases. Diseases that had abnormal background (irrespective of seizure) were asphyxia and HIE (24cases), sepsis and meningitis (4cases), metabolic disorders (2case), disease of unknown reason (1case).(2) The detection rate of seizures in these infants was25.0%. Diseases that had normal background but aEEG seizures were intracranial hemorrhage (1case), hypoglycemia (1case), hypocalcemia (2cases), pulmonary stenosis (1case), viral meningitis (1case), and seizures of unknown reasons (17cases).Conclusion:Term infants at risk of brain damage caused by variety of diseases could be monitored with aEEG. It has a good application value when applied to predict the severity of HIE, monitor seizures and early indentify the infants with underlying brain damage who had abnormal neurological symptoms or signs. Part twoContinuous Amplitude-Integrated Electroencephalography Monitoring in Neonates with Hypoxic-Ischemic Encephalopathy Treated with Erythropoietin and HypothermiaObjective:To describe the evolution of amplitude-integrated electroencephalography (aEEG) background in full term infants in a randomized controlled trial to treat hypoxic-ischemic encephalopathy (HIE) with erythropoietin (EPO) and hypothermia.Methods:From January2012to March2013,14term infants with evidence of HIE were randomly assigned to two groups:erythropoietin and hypothermia (n=6), or hypothermia alone (n=8). Continuous aEEG was performed during hypothermia and rewarming. MRI was used to assess the effect of this therapy.Results:(1)11infants had completed this therapy.1had a normal aEEG trace at admission, there was basal ganglia and thalamic (BGT) lesions on brain MRI;3infants had a mildly abnormal aEEG background, a normal MRI finding in1case, BGT lesions in two cases;5infants had a severely abnormal background, BGT lesions in4infants, normal imaging in1case.2infants had a normal background but seizures,1infant who developed repetitive seizures during hypothermia had lesions in frontal, parietal, temporal and occipital lobes and BGT;1who developed seizures during rewarming had temporal damage. Those infants who had aEEG abnormalities persisting beyond36hours after birth showed severe brain damage.(2) The therapy was ceased in another3infants.2infants had persist severely abnormal background and gave up the therapy on the third day, there were diffuse encephaledema on CT;1infant who had severely abnormal background stopped hypothermia on the first day, there were severe BGT lesions on MRI.Conlusions:aEEG background pattern before hypothermia is of predictive value in HIE infants. Continuous aEEG monitoring adds to the prognostic value, a persistently abnormal background pattern at36hours after birth predicts severe brain damage. Part threeThe relationship between the MRI findings and clinical features in22full-term infants with neonatal hypoglycemiaObjective:To evaluate the relationship between the MRI findings and clinical characteristics in full-term infants with neonatal hypoglycemia.Methods:The clinical records of22neonates with isolated hypoglycemia who were referred to Children’ Hospital of Fudan University from June1,2008to June30,2011were reviewed retrospectively. The patients were divided into two groups according to the early magnetic resonance imaging (MRI) findings:MRI-group (n=9) were patients who showed normal brain imaging while MRI+group (n=13) were patients who showed abnormal brain imaging finding. The clinical characteristics of neonatal hypoglycemia were compared between two groups. The brain damage patterns identified from early MRI scans were presented.Results:The frequencies of risk factors for hypoglycemia were similar in two groups (P=0.054). The duration when hypoglycemia was first detected was1(0.5-17) h in MRI-group and46.6(12.7-78.3) h in MRI+group, respectively, P=0.000. MRI-group established stable blood glucose levels faster than the MRI+group,(54.1±18.2) h vs (71.6±15.1) h, P=0.023. The occurrences of symptoms were more frequent in MRI+group than MRI group (P=0.000). Among MRI+group,10had predominant bilateral parieto-occipital cortex and subcortical white matter abnormalities,1had unilateral occipital and parietal area lesions,2had punctate white matter lesions in periventricular region or centrum semiovale.Conclusions:Screening and management of babies at risk for neonatal hypoglycemia are recommended. Infants who were identified less than12hours of postnatal age remained asymptomatic, and there were no changes in the MRI imaging. The time to establishment of the stable blood glucose levels might be suggestive of association with neuroimaging changes and long-term neurological changes. The most common area of hypoglycemia-associated brain damage was in the parietal and occipital lobes.