الفهرس 
N EONATAL H EMODYNAMICSOnly 14 pages are availabe for public view
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Abstract
Background: Amplitude-integrated electroencephalography (aEEG) has been used in clinical research to study the relationship between changes in neonatal cardiovascular function and brain activity.
Aim of the Work: To evaluate the impact of cardiovascular compromise on cerebral cortical activity (aEEG measurements) in non-asphyxiated neonates with persistent pulmonary hypertension of newborn (PPHN) or those with shock and hypotension and to identify neonates at risk for neurologic compromise and the relevance of an abnormal aEEG trace to associated hemodynamic changes, therapeutic interventions and short-term clinical outcome measures in these neonates.
Study design: Fifty critically-ill neonates (30-38 weeks’ gestation) with cardiovascular compromise; septic shock and hypotension (n=20), persistent pulmonary hypertension of newborn (PPHN) (n=5), or both (n=25), were enrolled into a prospective observational cohort study. All newborns were subjected to thorough history taking and clinical examination. SNAP II scoring and cardiorespiratory therapeutic interventions were recorded. Serum lactate and neuron specific enolase (NSE) levels were measured at enrollment. Functional echocardiographic evaluation and aEEG monitoring were commenced within the first 24 hours of enrollment and repeated 48-72 hours from weaned inotropic support (n=38), with follow-up of the patients to report their final outcome.
Results: Total aEEG scores were significantly lower among neonates with severe SNAP II score as compared to those with mild and moderate scores (p = 0.021). Initial superior vena cava (SVC) flow, right ventricular output (RVO) values and total aEEG scores were significantly lower (p=0.000, p=0.000, p=<0.001 respectively) in comparison to their corresponding follow-up records. Survivors (n=27) had significantly higher aEEG scores at initial and follow up assessment (p=0.002 & p=0.000) and significantly lower serum lactate and NSE levels (p=0.000 respectively), as compared to non-survivors. A significant positive correlation was found between total aEEG score and mean arterial blood pressure (r=0.504, p=0.000) at initial assessment, meanwhile, follow-up aEEG total scores were inversely correlated with both serum lactate and NSE levels (r=-0.455 & p=0.004) and (r = -0.488 & p = 0.002) respectively. Logistic regression analysis revealed that serum lactate level of > 34.3 mg/dl was a significantly high risk factor of mortality prediction with odds ratio (95% CI) of 44.00 (5.085 - 380.71), p = 0.001. ROC curve analysis showed NSE at cutoff value > 50 ng/ml has 83.3% PPV, 88.5% NPV, 86.96% sensitivity and 85.19% specificity for mortality prediction.
Conclusion: Significant derangement of brain electrical activity is encountered in critically-ill neonates with cardiovascular compromise. It could be speculated that aEEG monitoring of these neonates might help to predict their short-term clinical outcomes