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Vol. 90. Núm. 2.
Páginas 143-148 (Março - Abril 2014)
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Vol. 90. Núm. 2.
Páginas 143-148 (Março - Abril 2014)
ARTIGO ORIGINAL
Open Access
Clinical utility of early amplitude integrated EEG in monitoring term newborns at risk of neurological injury
Utilidade clínica de um monitoramento por EEG de amplitude integrada precoce em recém-nascidos a termo com risco de lesão neurológica
Visitas
3861
Paulina A. Tosoa,
Autor para correspondência
ptoso@med.puc.cl

Corresponding author.
, Alvaro J. Gonzáleza, María E. Pérezb, Javier Kattana, Jorge G. Fabresa, José L. Tapiaa, Hernán S. Gonzáleza
a Divisão de Pediatria, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
b Pontificia Universidad Católica de Chile, Santiago, Chile
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Informação do artigo
Abstract
Objective

to test the clinical utility of an early amplitude-integrated electroencephalography (aEEG) to predict short-term neurological outcome in term newborns at risk of neurology injury.

Methods

this was a prospective, descriptive study. The inclusion criteria were neonatal encephalopathy, neurologic disturbances, and severe respiratory distress syndrome. Sensitivity, specificity, positive and negative predictive values, and likelihood ratio (LR) were calculated. Clinical and demographic data were analyzed. Neurological outcome was defined as the sum of clinical, electroimaging, and neuroimaging findings.

Results

ten of the 21 monitored infants (48%) presented altered short-term neurologic out-come. The aEEG had 90% sensitivity, 82% specificity, 82% positive predictive value, and 90% negative predictive value. The positive LR was 4.95, and the negative LR was 0.12. In three of12 (25%) encephalopathic infants, the aEEG allowed for a better definition of the severity of their condition. Seizures were detected in eight infants (38%), all subclinical at baseline, and none had a normal aEEG background pattern. The status of three infants (43%) evolved and required two or more drugs for treatment.

Conclusions

in infants with encephalopathy or other severe illness, aEEG disturbances occur frequently. aEEG provided a better classification of the severity of encephalopathy, detectedearly subclinical seizures, and allowed for monitoring of the response to treatment. aEEG was a useful tool at the neonatal intensive care unit for predicting poor short-term neurologicaloutcomes for all sick newborn.

Keywords:
Amplitude integrated electroencephalography (aEEG)
Hypoxic ischemic encephalopathy (HIE)
Neonatal intensive care
Seizures
Resumo
Objetivo

testar a utilidade clínica do aEEG precoce em recém-nascidos a termo com risco delesão neurológica, para prever resultados neurológicos de curto prazo.

Métodos

estudo prospectivo e descritivo. Os critérios de inclusão foram encefalopatia neonatal, distúrbios neurológicos e bebês com SARA grave. Sensibilidade, especificidade, valor preditivo positivo e negativo e razão de verossimilhança foram calculados. Dados clínicos edemográficos foram analisados. O resultado neurológico foi definido como a soma de conclusões clínicas, de eletro e de neuroimagem.

Resultados

dentre os 21 neonatos monitorados, dez (48%) apresentaram resultado neu- rológico de curto prazo alterado. O aEEG apresentou sensibilidade de 90%, especificidade de 82%, valor preditivo positivo de 82% e valor preditivo negativo de 90%. A VR positiva foi de 4,95, e a RV negativa de 0,12. Em três dos 12 (25%) neonatos com encefalopatia foi possível definir melhora gravidade de sua condição pelo aEEG. Foram detectadas convul- sões em oito neonatos (38%), todas subclínicas no início do estudo, e nenhum apresentou um padrão histórico normal no aEEG. O estado de três neonatos (43%) evoluiu e exigiu dois ou mais medicamentos para tratamento.

Conclusões

em neonatos com encefalopatia ou outra doença grave, os distúrbios no aEE- Gocorrem com mais frequência. O aEEG forneceu uma classificação melhor da gravidade da encefalopatia, detectou convulsões subclínicas precoces e permitiu que fosse feito o monitoramento da resposta ao tratamento. O aEEG é uma ferramenta útil para prever resultados neurológicos de curto prazo em todos os bebês doentes na UTIN.

Palavras-chave:
Eletroencefalo- gramade amplitude integrada (aEEG)
Encefalopatia hipóxico-isquêmica (EHI)
Terapia intensiva neonatal
Convulsões
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Como citar este artigo: Toso PA, González AJ, Pérez ME, Kattan J, Fabres JG, Tapia JL, et al. Clinical utility of early amplitude inte- grated EEG in monitoring term newborns at risk of neurological injury. J Pediatr (Rio J). 2014;90:143-8.

Unidade de Terapia Intensiva Neonatal, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile.

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