Amplitude-Integrated Electroencephalography Coupled With an Early Neurologic Examination Enhances Prediction of Term Infants at Risk for Persistent Encephalopathy

DOI PDF 被引用文献5件
  • Lina F. Shalak
    From the Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
  • Abbot R. Laptook
    From the Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
  • Sithembiso C. Velaphi
    From the Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
  • Jeffrey M. Perlman
    From the Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

抄録

<jats:p>Objectives. The objectives of this study were to determine, first, whether an early neurologic examination could predict a persistent abnormal neonatal neurologic state comparable to the amplitude-integrated electroencephalography (a-EEG) and, second, whether a combination of the 2 methods would further enhance early identification of high-risk infants.</jats:p><jats:p>Methods. Fifty term infants were enrolled prospectively when they had evidence of intrapartum distress, Apgar score ≤5 at 5 minutes, or cord arterial pH ≤7.00 and were admitted to intensive care. Each enrolled infant underwent an early neurologic examination using a modified Sarnat staging system (stages 2 and 3 were regarded as abnormal) and a blinded simultaneous a-EEG measurement. Predictive values were calculated for a short-term abnormal outcome defined as persistent moderate to severe encephalopathy beyond 5 days.</jats:p><jats:p>Results. An abnormal short-term outcome was present in 14 (28%) of 50 infants. The neurologic examination was performed at 5 ± 3 hours after delivery. A short-term abnormal outcome occurred in 9 (53%) of 17 infants with initial stage 2 and in both infants with initial stage 3 encephalopathy. In addition, 13 infants manifested features of both stage 1s and 2 and post hoc were classified (S1–2). Three of the latter infants (23%) developed an abnormal short-term outcome. The a-EEG was abnormal in 15 (30%) infants, 11 (73%) of whom developed an abnormal outcome. An abnormal a-EEG was more specific (89% vs 78%), had a greater positive predictive value (73% vs 58%), and had similar sensitivity (79% vs 78%) and negative predictive value (90% vs 91%) when compared with an abnormal early neurologic examination. A combination of abnormalities had the highest specificity (94%) and positive predictive value (85%).</jats:p><jats:p>Conclusion. The combination of the a-EEG and the neurologic examination shortly after birth enhances the ability to identify high-risk infants and limits the number of infants who would be falsely identified compared with either evaluation alone.</jats:p>

収録刊行物

  • Pediatrics

    Pediatrics 111 (2), 351-357, 2003-02-01

    American Academy of Pediatrics (AAP)

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