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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (5): 369-374.DOI: 10.3969/j.issn.1673-5501.2023.05.007

• 论著 • 上一篇    下一篇

新生儿周期性放电167例病例系列报告

方秀英1a,王英杰1b,毛健1b   

  1. 1 中国医科大学附属盛京医院 沈阳，110004，a神经功能科，b新生儿科
  • 收稿日期:2023-09-26 修回日期:2023-10-14 出版日期:2023-10-25 发布日期:2023-10-25
  • 通讯作者: 毛健

167 cases of periodic discharges in neonates: A case series report

FANG Xiuying1a, WANG Yingjie1b, MAO Jian1b   

  1. 1 Shengjing Hospital of China Medical University, Shenyang 110004，China, a Department of Neurology，b Department of Neonatology
  • Received:2023-09-26 Revised:2023-10-14 Online:2023-10-25 Published:2023-10-25
  • Contact: MAO Jian

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摘要： 背景：在成人和儿童重症患者脑电图监测中周期性放电（PDs）越来越得到关注，PDs与癫发作的相关性很高。但到目前为止，新生儿人群中关于PDs的研究报道非常少。新生儿期PDs仍是一种临床意义不明的脑电现象。 目的：探讨新生儿PDs的发生率，病因学特点，与惊厥发作的关系和与脑损伤的相关性。 设计：病例系列报告。 方法：收集2018年1月至2022年12月在中国医科大学附属盛京医院行视频脑电图（vEEG）监测的新生儿病例资料，于脑电图数据库中搜索出现惊厥发作和PDs的新生儿，重新判读其脑电图资料和头颅MR检查结果，分析汇总临床资料。 主要结局指标：新生儿PDs发生率。 结果：4 685例新生儿中167例（3.6%）发生PDs，足月儿以缺血缺氧性脑病（HIE）、脑白质损伤及颅内感染为最主要的病因，早产儿则为颅内出血、脑白质损伤和HIE。93.4%患儿监测到电发作或电-临床发作，54.5%为多次发作或频繁发作，37.1%出现惊厥持续状态。68例（40.7%）在某一脑区单灶反复出现，47例（28.1%)呈多灶非同步发放，29例（17.4%)呈一侧半球同步出现，23例（13.8%)双半球同步出现。单灶反复出现和多灶非同步发放的115例中，89例（77.4%)涉及中央区和/或中线区以及颞区。PDs病因中，HIE、动脉缺血性卒中、颅内出血、颅内感染、脑白质损伤和不明原因惊厥与PDs不同发放部位差异有统计学意义。129例（77.2%）不同部位的脑损伤存在PDs，局灶或多灶性微小白质损伤、一侧半球大面积损伤和广泛性全脑性损伤与PDs不同发放部位差异有统计学意义。132例完成2次及以上监测的患儿中，43.9%于起病后第1~7天PDs逐渐消失，28.0%于第8~14天消失，12.1%于第15~32天消失；15.9%多次复查PDs持续存在，多见于先天性脑结构发育异常和基因异常的患儿。 结论：新生儿时期PDs发生率低，具有多种潜在的病因，与惊厥发作关系密切，与结构性脑损伤或功能紊乱相关。PDs可以视为新生儿脑损伤急性期的特征性EEG改变之一。

关键词: 周期性放电, 新生儿, 视频脑电图, 脑损伤, 惊厥发作

Abstract: Background：Periodic discharges (PDs）have attracted more and more attention in electroencephalogram (EEG) monitoring of adult and pediatric critical patients, and the correlation between PDs and seizures is very high. But so far, there are very few reports on PDs in newborns. Neonatal PD is still an EEG phenomenon with unknown clinical significance. Objective：To investigate the incidence and etiological characteristics of PDs in neonates, and the correlation with seizures and brain injury. Design：Case series report. Methods：The data of neonatal cases monitored by video electroencephalogram (vEEG) in Shengjing Hospital Affiliated to China Medical University from January 2018 to December 2022 were collected. Newborns with seizures and PDs were searched in the EEG database, and their EEG data and head magnetic resonance imaging (MRI) results were reinterpreted, and the clinical data were analyzed and summarized. Main outcome measures：Incidence of PDs in neonates. Results：Out of 4 685 neonates, 167 (3.6%) developed PDs. The primary causes of PDs for full-term infants were hypoxic-ischemic encephalopathy, white matter injury, and intracranial infection, while for preterm infants the primary causes are cerebral hemorrhage, white matter injury, and hypoxic-ischemic encephalopathy. Electrical or electro-clinical seizures were detected in 93.4% of the neonates, 54.5% had multiple or frequent seizures, and 37.1% had status epilepticus. Sixty-eight cases (40.7%) had recurrent single foci in a certain brain region, 47 cases (28.1%) had multifocal asynchrony, 29 cases (17.4%) had simultaneous appearance in one hemisphere, and 23 cases (13.8%) had simultaneous appearance in both hemispheres. Of the 115 cases with single-focal recurrence and multi-focal asynchrony, 89 cases (77.4%) involved the central and/or midline regions and the temporal region. Among the causes of PDs, statistical significance was found between different PD sites and PD causes of hypoxic ischemic encephalopathy, arterial ischemic stroke, intracranial hemorrhage, intracranial infection, white matter injury, and unexplained convulsion. There were 129 cases (77.2%) with PDs in different parts of brain injury. There was statistical significance between different PD distribution sites and focal or multifocal micro-white matter injury, large area injury in one hemisphere，and extensive whole brain. Among the 132 children who completed at least two monitoring, 43.9% of PDs gradually disappeared 1-7 days after onset, 28.0% disappeared at 8-14 days after onset, and 12.1% disappeared at 15-32 days after onset. Besides, 15.9% of the neonates with persistent PDs had congenital brain structural abnormalities and genetic abnormalities. Conclusions：The incidence of PDs in neonates is low, and there are many potential causes. It is closely related to seizures. PDs are associated with structural brain injury or dysfunction. PDs can be regarded as one of the characteristic EEG changes in the acute phase of neonatal brain injury.

Key words: Periodic discharge, Neonate, Video EEG, Brain injury, Seizures