The Value Of AEEG In Early Diagnosis And Prediction Of Prognosis In HIE In Northwest Yunnan

BackgroundHypoxic ischemic encephalopathy(HIE)is a major cause of neonatal death and disability in childhood,and the incidence and mortality rate of HIE is among the highest in China due to the high altitude,low oxygen content of the air(only 15-17%in northwest Yunnan)and relatively poor medical conditions of newborns born on the plateau.Subcritical treatment is the only safe and effective neuroprotective treatment known to man.However,the diagnosis of HIE currently relies only on history and physical examination,and the clinical manifestations of HIE usually appear only 6hours after birth.Sub-hypothermia therapy needs to be applied early(within 6 hours)to be effective,and in order to provide effective sub-hypothermia therapy,clinicians should assess newborns within 6 hours of birth.Therefore,the development of methods for early prediction and screening of neonatal HIE is essential for the prevention and treatment of HIE.Amplitude-integrated electroencephalography(aEEG)has been found to be an important method for diagnosing brain injury within6 h of birth.Many studies have shown that aEEG monitoring of children with HIE within 6 hours of birth can provide an early and accurate diagnosis of HIE and determine the prognosis of children with moderate to severe HIE.ObjectiveTo reduce neonatal mortality and disability in childhood,aEEG monitoring was implemented in the neonatal unit of the First Affiliated Hospital of Dali University(average altitude 2100 m)to investigate whether aEEG can assess the severity of brain damage in children born with HIE on the plateau in northwest Yunnan Province.The aim is to provide an effective method for early diagnosis of HIE and timely neuroprotective measures,thus effectively reducing the occurrence of apoptosis,decreasing neuronal death in the brain,achieving early intervention and improving the prognosis of HIE.MethodsEighty-four children with HIE,52 boys and 32 girls,with a birth weight of(3230±460)g,who were admitted to the NICU between December 2020 and December 2022,and whose gestational age ranged from 35 weeks to 41+6 weeks and were clinically diagnosed with HIE,were selected for the study using a retrospective method.The children were divided into three groups according to the clinical classification of HIE: mild,moderate and severe.All the subjects underwent arterial blood gas analysis with radial blood collected within 1 hour after birth,continuous bedside aEEG testing within 6 hours for 2-4 hours and cranial MRI examination between 3 and 7 days after birth.All subjects were followed up to 4 months of age,and at 4 months of age,they were assessed on the Paediatric Heart Scale-II,which was used to calculate the developmental quotient in order to understand the neuropsychological development of the children.The correlation between the aEEG classification monitored within 6h of birth and the clinical classification of HIE,the p H,BE and Lac values of arterial blood gas analysis within 1h of birth,and the Apgar score at different times after birth was investigated;the correlation between the cranial MRI classification and the clinical classification and the aEEG classification at3-7 days after postgraduate study was investigated;children with HIE were also followed up until 4 months of age to investigate the correlation between the aEEG The correlation between the aEEG classification and the clinical score and the developmental quotient of the Developmental Behavioural Assessment Scale for Children 0-6 years old(hereafter referred to as the Paediatric Heart Scale-II),respectively.Results1.Among the 84 study subjects,21(25%)were clinically graded as mild HIE,of which 4(19.1%),17(80.9%)and 0 were normal,mild and severe aEEG abnormalities,respectively;57(67.9%)were clinically graded as moderate,of which 0,51(89.5%)and 6(10.5%)were normal,mild and severe aEEG abnormalities,respectively;and 6(7.1%)were clinically graded as severe,of which 0,1(16.7%)and 1(16.7%)were normal,mild and severe aEEG abnormalities,respectively.and 6 cases(10.5%);a total of 6 cases(7.1%)were clinically graded as severe,of which 0,1(16.7%)and 5(83.3%)were normal,mildly abnormal and severely abnormal aEEG,respectively.The Kruskal-Wallis test showed a significant difference in the distribution of aEEG classification results among the three groups with different clinical scores(p < 0.001).A two-way comparison showed statistically significant differences in the aEEG classification results of children with HIE in any two groups with different clinical gradations(p < 0.05).The spearman rank correlation test was significantly positive(r=0.527,p<0.001).There were significant differences in the distribution of cranial MRI scores among the three groups of children with HIE of different clinical scores;when a two-by-two comparison was performed,there were differences in cranial MRI between the mild and moderate HIE group,the mild and severe HIE group,and the moderate and severe HIE group;Spearman’s rank correlation analysis showed p < 0.001 and the correlation coefficient was 0.485.2.There was a significant difference in the distribution of cranial MRI scores among the three groups of children with HIE with different clinical scores(p<0.001).In a two-by-two comparison,the differences in head MRI scores between the mild and moderate HIE group,the mild and severe HIE group,and the moderate and severe HIE group were statistically significant(p < 0.05);Spearman’s rank correlation analysis showed a significant positive correlation(r = 0.485,p < 0.001).The PH and BE values of the three groups of children with different aEEG classifications differed in the postnatal 1 h.The PH value decreased and the negative BE value increased significantly with the increase of aEEG abnormality.3.There was a significant difference in the distribution of cranial MRI scores for the three groups with different degrees of aEEG abnormality(p < 0.001).When a two-by-two comparison was performed,the differences in MRI distribution between the aEEG normal group and the mildly abnormal group,the aEEG normal group and the severely abnormal group,and the aEEG mildly abnormal group and the severely abnormal group were all statistically significant(p < 0.05).Spearman’s rank correlation analysis was performed and showed a significant positive correlation(r=0.567,p<0.001).4.The differences in p H and BE values between the three groups of children with different classifications of aEEG were statistically significant(p < 0.05)within the first postnatal hour.p H values decreased and negative BE values increased significantly as the degree of aEEG abnormality increased,but the differences in lactate values were not statistically significant(p > 0.05)when comparing between the groups with different aEEG abnormalities.5.The Kruskal-Wallis test showed a statistically significant difference(p < 0.05)in Apgar scores at different times for different degrees of aEEG classification of abnormality.When a two-by-two comparison was performed,the difference in Apgar scores at 5 min between any two groups with different degrees of abnormal aEEG classification was statistically significant(p < 0.05).The difference in Apgar scores between the normal aEEG group and the mildly abnormal group at 1min and 10 min was not statistically significant(p > 0.05).6.The differences in the distribution of developmental quotients by aEEG classification were statistically significant(p < 0.05).When a two-by-two comparison was performed,there was a statistically significant difference in developmental quotient between the aEEG severe abnormality group and the normal group,and between the aEEG severe abnormality group and the aEEG mild abnormality group(p < 0.05);while there was no statistically significant difference in developmental quotient between aEEG normal and aEEG mild abnormality(p > 0.05).Conclusion1.The aEEG classification and cranial MRI are consistent in the early determination of the extent of brain injury in HIE.2.Both cranial MRI and aEEG play an important role in the early diagnosis of HIE,but aEEG is superior to cranial MRI in terms of timeliness and convenience.3.aEEG monitoring within 6 h of birth in children with HIE in the plateau region of northwest Yunnan can provide early diagnosis of HIE and determine its severity.aEEG monitoring in children with HIE in the plateau region of northwest Yunnan can therefore provide a reference for timely subhypothermic treatment.4.p H and BE values of blood gas analysis within 1 h after birth should be taken seriously.The lower the p H value and the higher the negative BE value,the more likely brain injury will occur and should be considered as a high-risk group for aEEG monitoring.5.the Apgar score at 5 min has some significance in determining the prognosis of brain injury.6.The degree of aEEG abnormality is closely related to the neurodevelopmental prognosis.Early and active intervention for those with abnormal aEEG can improve the prognosis of children with HIE.