| Purpose To explore the value of amplitude integrated EEG(aEEG)in the early diagnosis and short-term prognostic evaluation of neonatal hypoxic-ischemic encephalopathy(HIE).MethodsFrom October 2019 to September 2020,Children who were admitted to our hospital for severe neonatal asphyxia were included in the study.All were examined with aEEG within 6 hours of birth and the cranial MRI was conducted at the flowing 3rd-7th day.According to whether or not the HIE is diagnosed at discharge,Children were divided into HIE group and non-HIE group.Compare whether there are differences in the results of aEEG in different groups,and analyze the value of aEEG background activity,sleep-wake cycle,and convulsive-like electrical activity in the early diagnosis and short-term prognosis evaluation of HIE.Furthermore,based on clinical manifestations,the HIE group was divided into 3 three sub-groups: mild HIE,moderate HIE and severe HIE.The evaluation results of Gesell scale at 6 months of age were utilized as the evaluation criteria for recent prognosis,and the correlation of aEEG monitoring results to the clinical diagnosis defined via HIE scores in children,cranial brain MRI at 3-7days after birth,and Gesell scale evaluation at 6 months of age was analyzed.Result1、A total of 58 Children were enrolled.in the aEEG background activity within the first 6 hours after birth,29 were normal,24 were mildly abnormal and 5 were severely abnormal.Thereafter 38 cases were confirmed to be HIE:21 cases of mild HIE,8 cases of moderate HIE and 9 cases of severe HIE.2、The association of incidence of HIE with the three monitoring indicators of aEEG(background activity,sleep wake cycle,convulsion-like electrical activity)was significant(P<0.05)by the Chi-square test.The positive prediction values for HIE were79.31%,77.41%,95.65%,and the negative forecasts were 48.28%,52.17% and 54.28%,respectively.The Spearman correlation analysis was conducted,and the results showed aEEG results were positively correlated with clinical diagnostic scores(r=0.639,P<0.05).The cranial brain MRI scanning indicated 35 abnormal cases,with an abnormal rate of 60.34 percent,and 29 cases of aEEG at the same time in 35 cases of MRI abnormalities.The aEEG results were positively correlated with MRI results through Kappa level correlation analysis(Kappa value=0.961,P<0.05).3、Two children died,the remaining 56 cases were regularly assessed growth and development,and at 6 months by the Gesell scale assessment,DQ normal in 46 cases,DQ suspicious abnormality in 6 cases,DQ abnormal in 4 cases.Comparing the two groups,there was a significant difference in the DQ value of 6 months of age(P=0.000,P<0.05)within children with moderate to severe aEEG.According to the statistical analysis of Fisher’s exact probability method,there were significant differences between abnormal background activity,convulsive-like electrical activity and normal DQ classification at 6 months of age(P<0.05).Conclusion1、Within 6 hours of birth,if aEEG monitored abnormal background activity,abnormal sleep wake cycle and convulsive-like electrical activity were detected,the incidence of HIE was obviously higher.Therefore,we considered that the aEEG results of 6 hours after birth with severe asphyxia can be used as a useful supplement for the early diagnosis of HIE in newborns.2、The aEEG results of 6 hours after birth with severe asphyxia were positively correlated with the clinical diagnostic score of HIE and consistent with the results of cranial brain MRI examination.In newborns with moderate to severe aEEG abnormality,their DQ value is lower than ones with normal aEEG.wherein,newborns with aEEG background activity abnormal or monitored convulsive-like electrical activity,are likely to be DQ abnormality or suspicious abnormality.Therefore,it is believed that children with moderate to severe abnormalities in aEEG are likely to have a poor neurological prognosis in the near future. |
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