Analysis Of The Application Value Of Amplitude-integrated Electroencephalogram In Full-term Neonates With Asphyxia

Objective:Brain injury after asphyxia can lead to death and different types and degrees of nervous system outcomes.In this study,we retrospectively studied the clinical data of full-term neonates with asphyxia and explored the application value of amplitude-integrated electroencephalogram(aEEG)in these areas,such as comprehensive,objective,and accurate assessment of the extent of brain damage in children with asphyxia in the early stage,the early guidance intervention and rehabilitation treatment,predicting the prognosis of long-term nervous system and other aspects.Methods:From January 2016 to October 2018,91 cases of full-term neonates with asphyxia that were 37 weeks<gestational age<42 weeks,Apgar score of 1 minute<7,finished amplitude integrated EEG in 7 days after birth,excluded other diseases that may cause brain damage were collected for this retrospective study at the neonatal ward of Children’s Hospital of Soochow University.According to Apgar score,91 cases were divided into mild asphyxia group and severe asphyxia group.(1)Compare the basic clinical data of the two groups.(2)Compare the relationship between the abnormal rate,the degree of abnormality of aEEG and the examination time,the degree of asphyxia and the index of hypoxic-ischemic encephalopathy(HIE).(3)Analyze the relevance between the index of aEEG and the skull magnetic resonance imaging(MRI)and neurobehavioral prognosis.(4)Use the receiver operating characteristic curve(ROC)to compare the predictive power of HIE between aEEG and skull MRI.(5)Sensitivity,specificity.positive predictive value,and negative predictive value of aEEG for predicting HIE,predicting abnormal developmental quotient.Results:(1)The gender,mode of production,birth weight,gestational age,amniotic fluid contaminated with meconium,intrauterine distress,and the time for examination of aEEG were not significantly different between the two groups(P>0.05).(2)The graph of background activity,the maturity of sleep wake cycle(SWC),seizure activity were statistically significant with the time for examination of aEEG(P<0.05).The earlier the time for examination of aEEG,the more abnormal the pattern of background activity(r=-0.269,P=0.010),the less mature the SWC(r=-0.408,P<0.001),the higher the incidence rate of seizure activity(r=-0.229,P=0.029).(3)The graph of background activity,the maturity of SWC,the results of seizure activity were statistically significant with the degree of asphyxia(P<0.001).As the degree of asphyxia increased,the pattern of background activity was more abnormal(r=0.504,P<0.001),the more immature the formation of SWC or There was no SWC formation(r=0.441,P<0.001),the higher the incidence of seizure activity(r=0.376,P<0.001).(4)The graph of background activity,the maturity of SWC,the results of seizure activity were statistically significant with the clinical classification of HIE(P<0.05).The more severe the clinical classification of HIE,the more abnormal the pattern of background activity(r=0.504,P=0.003),the more immature the formation of SWC(r=0.482,P=0.004),the higher the seizure activity incidence(r=0.476,P=0.005).(5)The difference between the index of MRI and the index of aEEG was statistically significant(χ2=50.675,P<0.001),the abnormality of aEEG was highly correlated with the abnormality of MRI(r=0.729,P<0.001).(6)The difference between the index of aEEG and neurobehavioral prognosis was statistically significant(χ2=18.767,P=0.001),the index of aEEG was moderately correlated with the abnormality of neurobehavioral prognosis(r=0.497,P<0.001).(7)The predictive accuracy of aEEG in children with HIE was higher(area under curve(AUC)=0.937,P<0.001);the predictive accuracy of aEEG in children with moderate to severe HIE was moderate(AUC=0.877,P=0.004);aEEG and MRI both have higher prediction accuracy in 67 children with asphyxia,aEEG:AUC=0.930,P<0.001,MRI:AUC=0.919,P<0.001.(8)The abnormal background activity of aEEG predicts the sensitivity of HIE is 84.85%,specificity is 79.31%,positive predictive value is 70.00%,negative predictive value is 90.20%;the abnormality of SWC predicts the sensitivity of HIE is 60.61%,specificity is 94.83%,positive predictive value is 86.96%,negative predictive value is 80.88%;the abnormality of seizure activity predicts the sensitivity of HIE is 45.45%,specificity is 100.00%,positive predictive value is 100.00%,negative predictive value is 76.32%.(9)The abnormal background activity of aEEG predicts the sensitivity of the abnormal developmental quotient is 92.31%,specificity is 64.15%,positive predictive value is 38.71%,negative predictive value is 97,14%;the abnormality of SWC predicts the sensitivity of abnormal developmental quotient is 53.85%,Specificity is 86.79%,positive predictive value is 50.00%,negative predictive value is 88.46%;the abnormality of seizure activity predicts the sensitivity of abnormal developmental quotient is 46.15%,specificity is 88.68%,positive predictive value is 50.00%,negative predictive value is 87.04%.Conclusion:(1)The earlier the time for examination of aEEQ the heavier the asphyxia and the heavier the degree of HIE,the higher the abnormal rate of aEEG and the more abnormal the degree.(2)The index of MRI was statistically associated with the index of aEEG in monitoring brain injury of child after asphyxia.(3)Both aEEG and skull MRI can provide early predictive value for HIE.The early prediction of aEEG had a high accuracy of HIE.The early prediction of moderate to severe HIE was moderate in children with HIE.To predict HIE,the sensitivity of abnormal background activity is high,the specificity of SWC and seizure activity are high.(4)The abnormality of aEEG in neonates with asphyxia was moderately correlated with the abnormality of neurobehavioral prognosis,to predict abnormal aberrant quotient,the sensitivity of abnormal background activity is high,the specificity of SWC and seizure activity are high.