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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Prognostic tests in term neonates with hypoxic-ischemic encephalopathy: A systematic review
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Prognostic tests in term neonates with hypoxic-ischemic encephalopathy: A systematic review

机译：足月新生儿缺氧缺血性脑病的预后测试：系统评价

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BACKGROUND AND OBJECTIVE: Hypoxic-ischemic encephalopathy (HIE) after perinatal asphyxia in term neonates causes long-term neurologic sequelae or death. A reliable evidence-based prognosis is essential. The study goal was to investigate the prognostic value of currently used clinical tests in neonatal patients with perinatal asphyxia and HIE. METHODS: Searches were made on MEDLINE, Embase, Central, and CINAHL for studies occurring between January 1980 and November 2011. Studies were included if they (1) evaluated outcome in term infants with perinatal asphyxia and HIE, (2) evaluated prognostic tests, and (3) reported outcome at a minimal follow-up age of 18 months. Study selection, assessment of methodologic quality, and data extraction were performed by 3 independent reviewers. Pooled sensitivities and specificities of investigated tests were calculated when possible. RESULTS: Of the 259 relevant studies, 29 were included describing 13 prognostic tests conducted 1631 times in 1306 term neonates. A considerable heterogeneity was noted in test performance, cut-off values, and outcome measures. The most promising tests were amplitudeintegrated electroencephalography (sensitivity 0.93, [95% confidence interval 0.78-0.98]; specificity 0.90 [0.60-0.98]), EEG (sensitivity 0.92 [0.66-0.99]; specificity 0.83 [0.64-0.93]), and visual evoked potentials (sensitivity 0.90 [0.74-0.97]; specificity 0.92 [0.68-0.98]). In imaging, diffusion weighted MRI performed best on specificity (0.89 [0.62- 0.98]) and T1/T2-weighted MRI performed best on sensitivity (0.98 [0.80-1.00]). Magnetic resonance spectroscopy demonstrated a sensitivity of 0.75 (0.26-0.96) with poor specificity (0.58 [0.23-0.87]). CONCLUSIONS: This evidence suggests an important role for amplitudeintegrated electroencephalography, EEG, visual evoked potentials, and diffusion weighted and conventional MRI. Given the heterogeneity in the tests' performance and outcomes studied, well-designed large prospective studies are needed.
机译：背景与目的：足月新生儿围产期窒息后缺氧缺血性脑病（HIE）会引起长期的神经系统后遗症或死亡。可靠的循证预后至关重要。本研究的目的是调查当前使用的临床检查对新生儿围生期窒息和HIE患者的预后价值。方法：对1980年1月至2011年11月之间进行的MEDLINE，Embase，Central和CINAHL进行了研究。研究是否包括以下内容：（1）评估了围生期窒息和HIE足月儿的结局，（2）评估了预后， （3）报道的最低随访年龄为18个月。研究的选择，方法学质量的评估和数据提取均由3名独立审阅者进行。在可能的情况下，计算汇总的敏感性和研究试验的特异性。结果：在259项相关研究中，包括29项研究，描述了1306例足月新生儿中进行了16次31次预后测试。在测试性能，临界值和结果测量中发现了很大的异质性。最有希望的测试是振幅积分脑电图（灵敏度0.93，[95％置信区间0.78-0.98];特异性0.90 [0.60-0.98]），脑电图（灵敏度0.92 [0.66-0.99];特异性0.83 [0.64-0.93]）和视觉诱发电位（灵敏度0.90 [0.74-0.97];特异性0.92 [0.68-0.98]）。在成像中，扩散加权MRI的特异性最佳（0.89 [0.62- 0.98]），而T1 / T2加权MRI的敏感性最佳（0.98 [0.80-1.00]）。磁共振波谱显示灵敏度为0.75（0.26-0.96），特异性较差（0.58 [0.23-0.87]）。结论：该证据表明在振幅积分脑电图，脑电图，视觉诱发电位，弥散加权和常规MRI中起重要作用。考虑到测试性能和研究结果的异质性，需要精心设计的大型前瞻性研究。

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