Assuntos
Complicações Intraoperatórias/terapia , Guias de Prática Clínica como Assunto , Escoliose/cirurgia , Traumatismos da Medula Espinal/terapia , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Algoritmos , Criança , Terapia Combinada , Contraindicações , Drenagem , Humanos , Hipotermia Induzida , Fixadores Internos/efeitos adversos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/prevenção & controle , Hipertensão Intracraniana/cirurgia , Complicações Intraoperatórias/tratamento farmacológico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Isquemia/etiologia , Isquemia/prevenção & controle , Isquemia/terapia , Metilprednisolona/uso terapêutico , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/estatística & dados numéricos , Fármacos Neuroprotetores/uso terapêutico , Medula Espinal/irrigação sanguínea , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/prevenção & controleRESUMO
OBJECTIVES: The objective of this study was to analyze the usefulness of electrophysiological studies [electroencephalogram (EEG) and auditory-evoked potential (AEP)] during the follow-up of children with perinatal asphyxia antecedents. PATIENTS AND METHODS: A prospective epidemiological study of perinatal asphyxia in term neonates born at the University Hospital San Juan (Alicante, Spain) between November 1991 and February 1995 was performed. Perinatal asphyxia was graded as non-severe (1 minute Apgar score < or = 6 and/or umbilical artery pH < 7.20, with abnormal fetal heart patterns and/or meconium-stained amniotic fluid and the need for immediate neonatal resuscitation) and severe (1 minute Apgar score < or = 3 and umbilical artery pH < 7.10). The incidence of hypoxic-ischemic encephalopathy (classification of Levene and Sarnat & Sarnat) during the neonatal period and neurological sequelae (classification of Finer and Amiel-Tison) during the follow-up period were studied. Electrophysiological studies (EEG and AEP) were made mainly between 12 and 18 months of life. RESULTS: During the study period there were 156 cases of perinatal asphyxia in full-term live births (31 severe and 125 non-severe). Hypoxic-ischemic encephalopathy was present in 25.6% of asphyxiated newborn infants, being mild in 30 cases, moderate in 5 and severe in 5. The incidence of neurological sequelae in 115 asphyxiated newborns followed for 24 month was 16.5%. This included mainly motor disabilities. We did not find any case of epilepsy, but there were 4 children with febrile seizures and one case of benign myoclonic seizures. EEG was performed in 88 cases during follow-up, and only was abnormal in two infants without seizures. AEP was performed in 82 cases during follow-up and hearing loss was detected in 4 children with neurosensorial hypoacusia (3 unilateral and 1 bilateral). CONCLUSIONS: Rutinary EEG is not useful during follow-up of children with antecedents of perinatal asphyxia. However, AEP is a hearing screening procedure for infants at risk of deafness, such as in perinatal asphyxia, and the cases of neurosensorial hearing loss detected by AEP in our population were clinically unapparent.
