Pediatrician (St. Petersburg)Pediatrician (St. Petersburg)Педиатр2079-78502587-6252Eco-Vector3460610.17816/PED11273-84ReviewsОбзорыResearch ArticleChanges in the electrobiological activity of the brain in full-term newborns with hypoxic-ischemic encephalopathyИзменения электробиологической активности головного мозга у доношенных новорожденных с гипоксически-ишемической энцефалопатиейMelashenkoTatyana V.МелашенкоТатьяна Владимировна
Russian Federation

MD, PhD, Resident doctor, Intensive Care Unit for Newborns

канд. мед. наук, ординатор отделения реанимации и интенсивной терапии новорожденных

melashenkotat@mail.ruFominaMaria Yu.ФоминаМария Юрьевна
Russian Federation

MD, PhD, Dr Med Sci, Professor, Department of Psychoneurology AF and DPO

д-р мед. наук, профессор, кафедра неонатологии с курсами неврологии и акушерства-гинекологии ФП и ДПО

myfomina@mail.ruSt. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный педиатрический медицинский университет» Министерства здравоохранения Российской Федерации0806202011273840406202004062020Copyright ©; 2020, Melashenko T.V., Fomina M.Y.Copyright ©; 2020, Мелашенко Т.В., Фомина М.Ю.2020Melashenko T.V., Fomina M.Y.Мелашенко Т.В., Фомина М.Ю.http://creativecommons.org/licenses/by/4.0https://journals.eco-vector.com/pediatr/article/view/34606

Early diagnosis of hypoxyc encephalopathy contributes to the timely correction of neurofunctional disorders, which reduces mortality and the severity of acute and distant neurological complications of cerebral injurie. The importance of early detection of cerebral disorders in newborns has become especially relevant with the introduction of therapeutic hypothermia in full-term infants with hypoxic encephalopathy. It has been established that with the early onset of therapeutic hypothermia, full-term neurological prognosis in the long-term period, including motor, is observed in full-term newborns. The correspondence between structural disorders and neurophysiological changes in the brain at different age periods is proved. Among the methods for the early diagnosis of cerebral injuries in newborns, the electroencephalogram is one of the leading places. The correspondence between structural disorders and neurophysiological changes in the brain at different age periods is proved. Such characteristics of the electroencephalography method as non-invasiveness, high sensitivity in assessing neurobiological activity, safety, delicacy in maintaining the stability of a critical patient, allows electroencephalography in newborns from the first hours of life. The relevance of the review is associated not only with the scattered information about changes in the electrical activity of the brain in children with hypoxic-ischemic encephalopathy in the neo. Describes the main poor prognostic EEG patterns in the form of a suppression rate (decrease in the amplitude with the maximum manifestation of the oppression of the electrobiological activity in the form of a pattern burst – suppression), slowing of the basic rhythm, rarely revealed epileptic, epileptiform activity, focal sharp activity. Such characteristics of the electroencephalography method as non-invasiveness, high sensitivity in assessing neurobiological activity, safety, delicacy in maintaining the stability of a critical patient, allows electroencephalography in newborns from the first hours of life. The relevance of the review is associated not only with the scattered information about changes in the electrical activity of the brain in children with hypoxic-ischemic natal period, but also with the peculiarity of brain electrogenesis during the neonatal period.

Ранняя диагностика гипоксически-ишемической энцефалопатии способствует своевременной коррекции нейрофункциональных нарушений, позволяющей снизить летальность и тяжесть неврологических острых и отдаленных осложнений церебральных повреждений. Своевременное выявление церебральных нарушений у новорожденных детей стало особенно актуальным с введением в практику терапевтической гипотермии у доношенных новорожденных с гипоксической энцефалопатией. Показаны преимущества проведения ранней гипотермии (в первые 3 ч жизни) у новорожденных в сравнении с более отсроченной гипотермией. Установлено, что при раннем начале терапевтической гипотермии у доношенных новорожденных наблюдается менее тяжелый неврологический прогноз в отдаленном периоде, в том числе развивается менее выраженный моторный дефицит. Среди методов ранней диагностики церебральных повреждений у новорожденных электроэнцефалограмма занимает одно из ведущих мест. Доказано соответствие между структурными нарушениями и нейрофизиологическими изменениями головного мозга в разные возрастные периоды. Описаны основные прогностически неблагоприятные электроэнцефалографические паттерны в виде супрессии ритма (снижение амплитуды с максимальным проявлением угнетения электробиологической активности в виде паттерна «вспышка – подавление»), замедление основного ритма; реже выявляются эпилептическая, эпилептиформная активность, фокальная заостренная активность. Такие характеристики метода электроэнцефалографии, как неинвазивность, высокочувствительность в оценке нейробиологической активности, безопасность, деликатность в сохранении стабильности пациента, находящегося в критическом состоянии, позволяют применять электроэнцефалографию у новорожденных детей с первых часов жизни.

hypoxic encephalopathyelectroencephalographynewbornsгипоксическая энцефалопатияэлектроэнцефалографияноворожденныеМелашенко Т.В., Гузева В.В., Гузева О.В. Анализ данных электроэнцефалографии у новорожденных детей с постгипоксическим поражением головного мозга, перенесших длительную респираторную терапию // Нейрохирургия и неврология детского возраста. – 2011. – № 2. – С. 15–24. [Melashenko TV, Guzeva VV, Guzeva OV. Analysis of electroencephalogram’s data of the new-born babies with post-hypoxic lesions of brain, who have taken a long-term respiratory therapy. Neirokhirurgiia i nevrologiia detskogo vozrasta. 2011;(2):15-24. (In Russ.)]Понятишин А.Е., Пальчик А.Б. Электроэнцефалография в неонатальной неврологии. – СПб.: СОТИС, 2006. [Ponyatishin AE, Pal’chik AB. Elektroentsefalografiya v neonatal’noy nevrologii. Saint Petersburg: SOTIS; 2006. (In Russ.)]Фомина М.Ю., Мелашенко Т.В., Павлова О.И. Неонатальные судороги у доношенных новорожденных: клинико-электрофизиологические особенности // Педиатр. – 2018. – Т. 9. – № 5. – С. 13–21. [Fomina MYu, Melashenko TV, Pavlova OI. Neonatal seizures in term infants: clinical and electrophysiological features. Pediatrician (St. Petersburg). 2018;9(5):13-21. (In Russ.)] https://doi.org/10.17816/PED9513-20.Allen KA, Brandon DH. Hypoxic Ischemic Encephalopathy: Pathophysiology and Experimental Treatments. Newborn Infant Nurs Rev. 2011;11(3):125-133. https://doi.org/10.1053/j.nainr.2011.07.004.Almubarak S, Wong PK. Long-term clinical outcome of neonatal EEG findings. J Clin Neurophysiol. 2011;28(2):185-189. https://doi.org/10.1097/WNP. 0b013e3182121731.Arfel G, Leonardon N, Moussalli F. Density and dynamic of frontal sharp waves (encoches pointues frontales) during sleep in new-borns and infants. Rev Electroencephalogr Neurophysiol Clin. 1977;7(3):351-360. https://doi.org/10.1016/s0370-4475(77)80014-2.Awal MA, Lai MM, Azemi G, et al. EEG background features that predict outcome in term neonates with hypoxic ischaemic encephalopathy: A structured review. Clin Neurophysiol. 2016;127(1):285-296. https://doi.org/10.1016/j.clinph.2015.05.018.Barbeau DY, Weiss MD. Sleep Disturbances in Newborns. Children (Basel). 2017;4(10). https://doi.org/10.3390/children4100090.Biagioni E, Boldrini A, Bottone U, et al. Prognostic value of abnormal EEG transients in preterm and full-term neonates. Electroencephalogr Clin Neurophysiol. 1996;99(1):1-9. https://doi.org/10.1016/0921-884x(96)95649-0.Chalia M, Lee CW, Dempsey LA, et al. Hemodynamic response to burst-suppressed and discontinuous electroencephalography activity in infants with hypoxic ischemic encephalopathy. Neurophotonics. 2016;3(3):031408. https://doi.org/10.1117/1.NPh.3.3.031408.Chowdhury RN, Hasan AH, Rahman KM, et al. Interictal EEG changes in patients with seizure disorder: experience in Bangladesh. Springerplus. 2013;2(1):27. https://doi.org/10.1186/2193-1801-2-27.Hee Jung C, Clancy RR. Significance of positive temporal sharp waves in the neonatal electroencephalogram. Electroencephalogr Clin Neurophysiol. 1991;79(4): 256-263. https://doi.org/10.1016/0013-4694(91) 90120-s.Clancy RR. Interictal sharp EEG transients in neonatal seizures. J Child Neurol. 1989;4(1):30-38. https://doi.org/10.1177/088307388900400105.Clancy RR, Legido A. The exact ictal and interictal duration of electroencephalographic neonatal seizures. Epilepsia. 1987;28(5):537-541. https://doi.org/10.1111/j.1528-1157.1987.tb03685.x.Crippa AC, Silvado CE, Paola L, et al. Analysis of frontal sharp transients in 32 neonatal polysomnography in healthy fullterm newborns. Arq Neuropsiquiatr. 2007;65(2A):222-227. https://doi.org/10.1590/s0004-282x2007000200007.Davidson JO, Wassink G, van den Heuij LG, et al. Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy – where to from here? Front Neurol. 2015;6:198. https://doi.org/10.3389/fneur.2015.00198.Dereymaeker A, Matic V, Vervisch J, et al. Automated EEG background analysis to identify neonates with hypoxic-ischemic encephalopathy treated with hypothermia at risk for adverse outcome: A pilot study. Pediatr Neonatol. 2019;60(1):50-58. https://doi.org/10.1016/j.pedneo.2018.03.010.Finn D, Dempsey EM, Boylan GB. Lost in Transition: A Systematic Review of Neonatal Electroencephalography in the Delivery Room-Are We Forgetting an Important Biomarker for Newborn Brain Health? Front Pediatr. 2017;5:173. https://doi.org/10.3389/fped.2017.00173.Globus GG. Quantification of the REM sleep cycle as a rhythm. Psychophysiology. 1970;7(2):248-253. https://doi.org/10.1111/j.1469-8986.1970.tb02230.x.Gunn AJ, Parer JT, Mallard EC, et al. Cerebral histologic and electrocorticographic changes after asphyxia in fetal sheep. Pediatr Res. 1992;31(5):486-491. https://doi.org/10.1203/00006450-199205000-00016.Holmes GL, Lombroso CT. Prognostic value of background patterns in the neonatal EEG. J Clin Neurophysiol. 1993;10(3):323-352. https://doi.org/10.1097/00004691-199307000-00008.Iyer KK, Roberts JA, Metsaranta M, et al. Novel features of early burst suppression predict outcome after birth asphyxia. Ann Clin Transl Neurol. 2014;1(3):209-214. https://doi.org/10.1002/acn3.32.Japaridze N, Muthuraman M, Reinicke C, et al. Neuronal Networks during Burst Suppression as Revealed by Source Analysis. PLoS One. 2015;10(4):e0123807. https://doi.org/10.1371/journal.pone.0123807.Jose A, Matthai J, Paul S. Correlation of EEG, CT, and MRI Brain with Neurological Outcome at 12 Months in Term Newborns with Hypoxic Ischemic Encephalopathy. J Clin Neonatol. 2013;2(3):125-130. https://doi.org/10.4103/2249-4847.119996.Kato T, Okumura A, Hayakawa F, et al. Prolonged EEG depression in term and near-term infants with hypoxic ischemic encephalopathy and later development of West syndrome. Epilepsia. 2010;51(12):2392-2396. https://doi.org/10.1111/j.1528-1167.2010.02727.x.Kharoshankaya L, Filan PM, Bogue CO, et al. Global suppression of electrocortical activity in unilateral perinatal thalamic stroke. Dev Med Child Neurol. 2014;56(7):695-698. https://doi.org/10.1111/dmcn.12365.Kroeger D, Florea B, Amzica F. Human brain activity patterns beyond the isoelectric line of extreme deep coma. PLoS One. 2013;8(9):e75257. https://doi.org/10.1371/journal.pone.0075257.Kumar A, Gupta A, Talukdar B. Clinico-etiological and EEG profile of neonatal seizures. Indian J Pediatr. 2007;74(1):33-37. https://doi.org/10.1007/s12098-007-0023-0.Lamblin MD, Walls Esquivel E, Andre M. The electroencephalogram of the full-term newborn: review of normal features and hypoxic-ischemic encephalopathy patterns. Neurophysiol Clin. 2013;43(5-6):267-287. https://doi.org/10.1016/j.neucli.2013.07.001.Low E, Dempsey EM, Ryan CA, et al. EEG suppression associated with apneic episodes in a neonate. Case Rep Neurol Med. 2012;2012:250801. https://doi.org/10.1155/2012/250801.Low E, Walsh B, Ryan C, Boylan G. 564 A Comparison of Electrographic Seizure Characteristics in Term Neonates with Hypoxic-Ischaemic Encephalopathy and Focal Cerebral Lesions. Pediatr Res. 2010;68(1):289. https://doi.org/10.1203/00006450-201011001-00564.Nosralla MdeO, Silva DF, Botelho RV. Significance of background activity and positive sharp waves in neonatal electroencephalogram as prognostic of cerebral palsy. Arq Neuropsiquiatr. 2009;67(3A):609-615. https://doi.org/10.1590/s0004-282x2009000400007.McCoy B, Hahn CD. Continuous EEG monitoring in the neonatal intensive care unit. J Clin Neurophysiol. 2013;30(2):106-114. https://doi.org/10.1097/WNP.0b013e3182872919.Menache CC, Bourgeois BFD, Volpe JJ. Prognostic value of neonatal discontinuous EEG. Pediatr Neurol. 2002;27(2):93-101. https://doi.org/10.1016/s0887-8994(02)00396-x.Murray DM, Boylan GB, Ryan CA, Connolly S. Early EEG findings in hypoxic-ischemic encephalopathy predict outcomes at 2 years. Pediatrics. 2009;124(3): e459-467. https://doi.org/10.1542/peds.2008-2190.Nabetani M, Okada Y, Kawai S, Nakamura H. Neural activity and the levels of high energy phosphates during deprivation of oxygen and/or glucose in hippocampal slices of immature and adult rats. Int J Dev Neurosci. 1995;13(1):3-12. https://doi.org/10.1016/0736-5748(95)95839-v.Naim MY, Gaynor JW, Chen J, et al. Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery. J Thorac Cardiovasc Surg. 2015;150(1):169-180. https://doi.org/10.1016/j.jtcvs.2015.03.045.Nanavati T, Seemaladinne N, Regier M, et al. Can We Predict Functional Outcome in Neonates with Hypoxic Ischemic Encephalopathy by the Combination of Neuroimaging and Electroencephalography? Pediatr Neonatol. 2015;56(5):307-316. https://doi.org/10.1016/j.pedneo.2014.12.005.Nash KB, Bonifacio SL, Glass HC, et al. Video-EEG monitoring in newborns with hypoxic-ischemic encephalopathy treated with hypothermia. Neurology. 2011;76(6):556-562. https://doi.org/10.1212/WNL.0b013e31820af91a.Niedermeyer E, Sherman DL, Geocadin RJ, et al. The burst-suppression electroencephalogram. Clin Electroencephalogr. 1999;30(3):99-105. https://doi.org/10.1177/155005949903000305.Osredkar D, Toet MC, van Rooij LG, et al. Sleep-wake cycling on amplitude-integrated electroencephalography in term newborns with hypoxic-ischemic encephalopathy. Pediatrics. 2005;115(2):327-332. https://doi.org/10.1542/peds.2004-0863.Pavlidis E, Lloyd RO, Boylan GB. EEG – A Valuable Biomarker of Brain Injury in Preterm Infants. Dev Neurosci. 2017;39(1-4):23-35. https://doi.org/10.1159/000456659.Perlman JM, Risser R. Can asphyxiated infants at risk for neonatal seizures be rapidly identified by current high-risk markers? Pediatrics. 1996;97(4): 456-462.Pierrat V, Haouari N, Liska A, et al. Prevalence, causes, and outcome at 2 years of age of newborn encephalopathy: population based study. Arch Dis Child Fetal Neonatal Ed. 2005;90(3): F257-261. https://doi.org/10.1136/adc.2003.047985.Pisani F, Spagnoli C. Monitoring of newborns at high risk for brain injury. Ital J Pediatr. 2016;42(1):48. https://doi.org/10.1186/s13052-016-0261-8.Pressler RM, Boylan GB, Morton M, et al. Early serial EEG in hypoxic ischaemic encephalopathy. Clin Neurophysiol. 2001;112(1):31-37. https://doi.org/10.1016/s1388-2457(00)00517-4.Rennie JM, de Vries LS, Blennow M, et al. Characterisation of neonatal seizures and their treatment using continuous EEG monitoring: a multicentre experience. Arch Dis Child Fetal Neonatal Ed. 2019;104(5):F493-F501. https://doi.org/10.1136/archdischild-2018-315624.Rennie JM, Boylan GB. Neonatal seizures. In: Recent Advances in Pediatrics. Ed. by J.J. David. Edinburgh: Churcill Livingstone; 2002. P. 19-32.Scher MS, Steppe DA, Beggarly ME, et al. Neonatal EEG-sleep disruption mimicking hypoxic-ischemic encephalopathy after intrapartum asphyxia. Sleep Med. 2002;3(5):411-415. https://doi.org/10.1016/s1389-9457(02)00071-0.Simiyu IN, McHaile DN, Katsongeri K, et al. Prevalence, severity and early outcomes of hypoxic ischemic encephalopathy among newborns at a tertiary hospital, in northern Tanzania. BMC Pediatr. 2017;17(1):131. https://doi.org/10.1186/s12887-017-0876-y.Shellhaas RA, Burns JW, Hassan F, et al. Neonatal Sleep-Wake Analyses Predict 18-month Neurodevelopmental Outcomes. Sleep. 2017;40(11). https://doi.org/10.1093/sleep/zsx144.Shen J, Mao SS, Yuan ZF, et al. Different Outcome with Different Aetiologies: The Prognosis Follow-up in 13 Infants with Bust — suppression Pattern. HK J Paediatr (New Series). 2016;21(1):7-13.Sher MS. Ontogenes of EEG sleep from neonatal through infancy period. Sleep Med. 2008;8(6):615-636.Scher MS. Normal electrographic-polysomnographic patterns in preterm and fullterm infants. Semin Pediatr Neurol. 1996;3(1):2-12. https://doi.org/10.1016/s1071-9091(96)80023-4.Sofue A, Okumura A, Hayakawa F, Watanabe K. Sharp waves in preterm infants with periventricular leukomalacia. Pediatr Neurol. 2003;29(3):214-217. https://doi.org/10.1016/s0887-8994(03)00221-2.Srinivasakumar P, Zempel J, Trivedi S, et al. Treating EEG Seizures in Hypoxic Ischemic Encephalopathy: A Randomized Controlled Trial. Pediatrics. 2015;136(5):e1302-e1309. https://doi.org/10.1542/peds.2014-3777.Thoresen M, Tooley J, Liu X, et al. Time Is Brain: Starting Therapeutic Hypothermia within Three Hours after Birth Improves Motor Outcome in Asphyxiated Newborns. Neonatology. 2013;104(3):228-233. https://doi.org/10.1159/000353948.van Laerhoven H, de Haan TR, Offringa M, et al. Prognostic Tests in Term Neonates With Hypoxic-Ischemic Encephalopathy: A Systematic Review. Pediatrics. 2012;131(1):88-98. https://doi.org/10.1542/peds.2012-1297.Volpe’s Neurology of the Newborn. 6th ed. Ed. by J.J. Volpe, T.E. Inder, B.T. Darras, et al. Philadelphia: Elsevier; 2018.Frasch Martin G, Wassink G, Bennet L, et al. Pre-Existing Hypoxia Is Associated with Greater EEG Suppression and Early Onset of Evolving Seizure Activity during Brief Repeated Asphyxia in Near-Term Fetal Sheep. PLoS ONE. 2013;8(8):e73895. https://doi.org/10.1371/journal.pone.0073895.Williams CE, Gunn A, Gluckman PD. Time course of intracellular edema and epileptiform activity following prenatal cerebral ischemia in sheep. Stroke. 1991;22(4):516-521. https://doi.org/10.1161/01.str.22.4.516.Zhang L, Zhou Y, Xu S. The etiology and outcome analysis of neonatal burst suppression EEG. J Huazhong Univ Sci Technolog Med Sci. 2007;27(5):622-624. https://doi.org/10.1007/s11596-007-0538-7.