RESUMEN
BACKGROUND: Delayed brain function development in small-gestational-age (SGA) infants has been reported. We aimed to quantify rates of immature neonatal EEG patterns and their association with neurodevelopment in SGA full-term neonates. METHODS: Using a cohort design, 50 SGA (birthweight <10th percentile) and 44 appropriate-gestational-age (AGA) term neonates underwent continuous video-EEG recordings lasting >3 h. Seventy-three of them were assessed at 2-years-old using Bayley-III-Scales. For EEG analysis, several segments of discontinuous/alternating EEG tracings were selected. MAIN OUTCOMES MEASURED: (1) Visual analysis (patterns of EEG maturity); (2) Power spectrum in δ, θ, α and ß frequency bands; and (3) scores in motor, cognitive and language development. RESULTS: (1) SGA infants, compared to AGA, showed: (a) higher percentages of discontinuous EEG, both asynchrony and interhemispheric asymmetry, and bursts with delta-brushes, longer interburst-interval duration and more transients/hour; (b) lower relative power spectrum in δ and higher in α; and (c) lower scores on motor, language and cognitive neurodevelopment. (2) Asymmetry >5%, interburst-interval >5 s, discontinuity >11%, and bursts with delta-brushes >11% were associated with lower scores on Bayley-III. CONCLUSIONS: In this prospective study, SGA full-term neonates showed high rates of immature EEG patterns. Low-birthweight and immaturity EEG were both correlated with low development scores.
Asunto(s)
Electroencefalografía/métodos , Retardo del Crecimiento Fetal/fisiopatología , Recién Nacido Pequeño para la Edad Gestacional , Peso al Nacer , Encéfalo/fisiopatología , Desarrollo Infantil , Estudios de Cohortes , Femenino , Retardo del Crecimiento Fetal/diagnóstico , Edad Gestacional , Humanos , Recién Nacido , Masculino , Pronóstico , Estudios Prospectivos , Visión OcularRESUMEN
La salud de la mayor parte del mundo desarrollado ha mejorado de forma significativa en años recientes gracias a los avances médicos y sociales, incluyendo mejoras diagnósticas y terapéuticas. Sin embargo, en este mismo mundo desarrollado un problema importante de salud pública no sólo no disminuye, sino al contrario, se incrementa. Se trata de la prematuridad. En efecto, la prematuridad representa un problema sociosanitario de primer orden, probablemente debido a las elevadas tasas de prevalencia que se registran actualmente (10% en España). Según el Instituto Nacional de Estadística (INE), en el año 2008 nacieron en España 519.779 niños, de los cuales 40.501 lo hicieron de forma prematura. Las causas de la prematuridad son multifactoriales y complejas, incluyendo infecciones, inflamaciones, enfermedad vascular, estrés y embarazos múltiples espontáneos o derivados de la reproducción asistida. A éstas hemos de añadirles factores de naturaleza socioeconómica (acceso a los cuidados prenatales), conducta materna durante la gestación (consumo de drogas y/o alcohol), e interacciones genética-ambiente. Dilucidar los mecanismos subyacentes que conducen a la prematuridad es una tarea ardua en la que están inmersos en la actualidad un número importante de investigadores de diversas disciplinas a nivel mundial. No obstante, la relación prematuridad-alteraciones neurológicas-repercusiones cognitivoconductuales a largo plazo dista de estar establecida de forma consistente. En este contexto, la Neuropsicología se muestra como un acercamiento válido y fiable para el estudio de los déficits cognitivos, así como del sustrato anatomopatológico generalmente identificado en la prematuridad
The health of most of the developed world has improved significantly in recent years thanks to medical advances and social changes including improvements in diagnostic and therapeutic methods. However, in developed countries a major public health problem does not decrease, but increases: prematurity. In fact, prematurity is a first class health problem to which significant human and material resources are devoted, probably due to high prevalence rates that are recorded (10% in Spain). According to the Spanish National Statistics Institute (INE), 519,779 children were born in 2008 in Spain, of which 40,501 did so prematurely. The causes of prematurity are multifactorial and complex, including infection, inflammation, vascular disease, stress and multiple pregnancies, spontaneous or resulting from assisted reproduction. Besides, new factors should be added like socio-economic factors (as access to prenatal care), maternal behavior during pregnancy (drug and/or alcohol abuse) and genetical-environmental interactions. To elucidate the underlying mechanisms that lead to prematurity is an arduous work in which a number of researchers from different disciplines worldwide are currently involved. However, the connection between prematurity, neurological disorders, and cognitive-behavioral effects in the long term is far from being consistently established. In this context, the Neuropsychology is shown as a valid and reliable approach for the study of cognitive deficits and pathological substrate usually identified in prematurity