Ciclo sono-vigília em recém-nascidos com encefalopatia hipóxico-isquêmica submetidos à hipotermia terapeutica
Data
2023-10-17
Autores
Rodrigues, Daniela 
Orientadores
Denise, Kusahara
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A hipotermia terapêutica (HT) é utilizada para neuroproteção etratamento a recém-nascidos (RN) que sofreram asfixia perinatal e apresentam sinais e sintomas de encefalopatia hipóxico-isquêmica (EHI) moderada ou grave. Nestaterapêutica o eletroencefalograma de amplitude integrada (aEEG/EEG) permiteavaliação da função e atividade cerebral contínua, oferecendo informações sobre aatividade elétrica de base, atividade epilética e avaliação do ciclo sono vigília (CSV)para fins diagnósticos e prognósticos. Objetivos: Verificar fatores associados àausência do CSV em recém-nascidos com EHI submetidos à HT e descrever osachados eletroencefalográficos e a evolução do CSV em RN com EHI submetidos àHT. Método: Estudo do tipo caso controle realizado entre julho/2017 a junho/2021após aprovação dos méritos éticos. A amostra foi composta por 72 RN sendo 36alocados no “Grupo Caso” (RN com EHI submetidos à HT sem CSV durante o períodode monitorização com vídeo aEEG/EEG) e 36 no Grupo Controle (RN com EHIsubmetidos à HT com CSV durante o período de monitorização com vídeoaEEG/EEG). Foram estudadas variáveis maternas relativas à gestação, trabalho departo e parto, variáveis relativas ao recém-nascido, HT, terapia intensiva, CSV emonitorização com aEEG/EEG. Os dados foram analisados segundo estatísticadescritiva e inferencial de acordo com a natureza das variáveis considerando-se 5%o nível de significância. Resultados: Os participantes foram monitorizados por 96horas, sendo a maioria do sexo masculino (59;77%), nascidos de parto cesárea(46;57%); com EHI moderada (52;72,2%). Onze RN de cada grupo apresentaramalterações na ultrassonografia de crânio. Não houve diferença estatisticamentesignificante entre os grupos de estudo quanto as características gestacionais, dos RNe complicações apresentadas durante a HT. Pela análise eletroencefalográfica, o CSVfoi ausente em 36 (50,0%) RN, com padrão patológico de atividade elétrica de baseem 31 (43,0%) e destes, 21 (29,1%) não atingiram traçado normal nas primeiras 72horas de vida. Foi encontrada diferença estatisticamente significante na presença depadrão patológico de atividade elétrica de base e na presença de crises epilépticas entre os grupos (p <0,0001;OR 0,071 e p<0,00;OR 0,200,
espectivamente), sendo apresença de CSV considerada um fator de proteção em ambos os casos. Conclusão:Cerca de metade dos RN com EHI submetidos à HT não apresentaram CSV durantetodo o período de monitorização, sendo que RN com achados anormais apresentaram alterações no CSV. O CSV foi considerado fator de proteção para a ocorrência deóbito sendo um marcador de desenvolvimento neurológico adequado e de bom prognóstico.
Background: Therapeutic hypothermia (TH) is used for neuroprotection and treatment of newborns who have suffered perinatal asphyxia and present signs and symptoms of moderate or severe hypoxicischemic encephalopathy (HIE). In this therapy, the amplitudeintegrated electroencephalogram (aEEG/EEG) also assessment of continuous brain function and activity, offering information on background electrical activity, epileptic activity, and assessment of the sleepwake cycle (SWC) for diagnostic and prognostic purposes. Objectives: To verify factors associated with the absence of SWC in newborns with HIE undergoing TH and to describe the electroencephalographic findings and the evolution of the SWC in newborns with HIE undergoing TH. Method: Casecontrol study carried out between July/2017 and June/2021 after approval of ethical merits. The sample consisted of 72 newborns, 36 of whom were allocated to the “Case Group” (newborns with HIE who underwent TH without SWC during the video aEEG/EEG monitoring period) and 36 in the “Control Group” (newborns with HIE who underwent TH with SWC during the video aEEG/EEG monitoring period). Maternal variables related to pregnancy, labor and delivery, newborn variables, TH, intensive care, SWC and aEEG/EEG monitoring were studied. Data was analyzed according to descriptive and inferential statistics according to the nature of the variables, considering a 5% level of significance. Results: Participants were monitored for 96 hours, the majority were male (59;77%), born by cesarean section (46;57%); with moderate HIE (52;72.2%). Eleven newborns in each group presented changes in the skull ultrasound. There was no statistically significant difference between the study groups regarding gestational characteristics, newborns and complications presented during TH. By electroencephalographic analysis, SWC was absent in 36 (50.0%) newborns, with a pathological pattern of baseline electrical activity in 31 (43.0%) and of these, 21 (29.1%) did not reach a normal trace in the first 72 hours of life. A statistically significant difference was found in the presence of a pathological pattern of baseline electrical activity and in the presence of epileptic seizures between the groups (p <0.0001;OR 0.071 and p<0.00;OR 0.200, respectively), with the presence of SWC considered a protective factor in both cases. Conclusion: Approximately half of the newborns with HIE undergoing TH did not present SWC during the entire monitoring period, with newborns with abnormal findings showing changes in the SWC. SWC was considered a protective factor for the occurrence of death, being a marker of adequate neurological development and a good prognosis.
Background: Therapeutic hypothermia (TH) is used for neuroprotection and treatment of newborns who have suffered perinatal asphyxia and present signs and symptoms of moderate or severe hypoxicischemic encephalopathy (HIE). In this therapy, the amplitudeintegrated electroencephalogram (aEEG/EEG) also assessment of continuous brain function and activity, offering information on background electrical activity, epileptic activity, and assessment of the sleepwake cycle (SWC) for diagnostic and prognostic purposes. Objectives: To verify factors associated with the absence of SWC in newborns with HIE undergoing TH and to describe the electroencephalographic findings and the evolution of the SWC in newborns with HIE undergoing TH. Method: Casecontrol study carried out between July/2017 and June/2021 after approval of ethical merits. The sample consisted of 72 newborns, 36 of whom were allocated to the “Case Group” (newborns with HIE who underwent TH without SWC during the video aEEG/EEG monitoring period) and 36 in the “Control Group” (newborns with HIE who underwent TH with SWC during the video aEEG/EEG monitoring period). Maternal variables related to pregnancy, labor and delivery, newborn variables, TH, intensive care, SWC and aEEG/EEG monitoring were studied. Data was analyzed according to descriptive and inferential statistics according to the nature of the variables, considering a 5% level of significance. Results: Participants were monitored for 96 hours, the majority were male (59;77%), born by cesarean section (46;57%); with moderate HIE (52;72.2%). Eleven newborns in each group presented changes in the skull ultrasound. There was no statistically significant difference between the study groups regarding gestational characteristics, newborns and complications presented during TH. By electroencephalographic analysis, SWC was absent in 36 (50.0%) newborns, with a pathological pattern of baseline electrical activity in 31 (43.0%) and of these, 21 (29.1%) did not reach a normal trace in the first 72 hours of life. A statistically significant difference was found in the presence of a pathological pattern of baseline electrical activity and in the presence of epileptic seizures between the groups (p <0.0001;OR 0.071 and p<0.00;OR 0.200, respectively), with the presence of SWC considered a protective factor in both cases. Conclusion: Approximately half of the newborns with HIE undergoing TH did not present SWC during the entire monitoring period, with newborns with abnormal findings showing changes in the SWC. SWC was considered a protective factor for the occurrence of death, being a marker of adequate neurological development and a good prognosis.