| Objectives: The aim of the study was to evaluate the significance of the amplitude integrated electroencephalography (aEEG) in the diagnosis and prognosis of neonate with hypoxic-ischemic encephalopathy (HIE), and meanwhile, to search a preferable technique which was suitable for the environment of the neonatel intensive care unit (NICU). In addition, the study also tried to simplify the investigation of cerebral function by monitoring aEEG.Methods: From July 2008 to October 2009, 42 term infants, with the gestation between 37+1 weeks and 41+5 weeks and suffering from various degrees of hypoxic-ischemic encephalopathy (HIE), were monitored by amplitude-integrated electroencephalography in 12h (8~14h) after birth. They were all delivered in the department of obstetrics and then transferred to the NICU, in the Second Hospital of Hebei Medical University. Among 42 infants, 27 males and 15 females were studied, with the birth weight 2550g~3910g (mean 3234g), the head circumference 31.5 cm ~35cm (mean 33.43cm), and the recumbent length 47.5cm~51.2cm (mean 49.67cm). The HIE was clinically classified into three grades (mild, moderate and severe), and the results of aEEG were categorized into three groups (normal aEEG, mildly abnormal aEEG, severely abnormal aEEG).The criteria of Naqueeb's was used for interpretation of the aEEG as by drawing lines through the upper and lower margins of the band of activity and scoring the pattern as follows:①normal amplitude, the upper margin >10μV and the lower margin >5μV.②moderately abnormal amplitude, the upper margin >10μV and the lower margin≤5μV.③suppressed amplitude, the upper margin <10μV and the lower margin <5μV. Normal amplitude belonged to normal aEEG. Moderately abnormal amplitude and normal amplitude with seizures belonged to mildly abnormal aEEG. Suppressed amplitude or moderately abnormal amplitude with seizures belonged to severely abnormal aEEG. The therapy of HIE is in accordance with the clinical routine made by China Medical Association's. The control group was made up by 10 full-term healthy neonates (5 males and 5 females), who were born in the Second Hospital of Hebei Medical University and with normal aEEG in 12h after birth. There were no differences between the control group and the HIE group in the gestation, sex, birth weight, head circumference, length, and etc. All subjects were followed up to six-month-old to observe their physical growth (the head circumference (HC), the recumbent length and the weight) and the nervous system development (neurological scoring, the occurrence of epilepsy). According to the growth and development, the prognosis of the HIE were divided into three kinds as follows: normal, abnormal (including physical retardation, nervous system abnormalities or epilepsy) and death (caused by HIE not other causes). The data were analyzed by SPSS13.0 statistical software and expressed with mean±standard deviation ( X±SD) Statistical analysis was performed by one-way ANOVA, Fisher's exact test, and Spearman correlation analysis, and Kappa statistics. P<0.05 was considered as significant.Results:1. The relativity between the categorization of the aEEG and the clinical graduation in neonate with HIEAmong 18 normal aEEG cases, mild HIE were 16 cases (88.9%) and moderate HIE were 2 cases (11.1%). Within 15 mild abnormal aEEG cases, mild HIE were 3 cases (20%), moderate HIE were 9 cases (60%) and severe HIE were 3 cases (20%). Severely abnormal aEEG neonates were 9 cases, mild HIE were 2 case (22.2%), severe HIE were 7 cases (77.8%). There was positive correlation between the aEEG and the clinical graduation of the HIE (Κ=0.633, P<0.001). Especially severely abnormal aEEG neonates, with an overwhelming majority, were severe HIE.2. The comparison of the growth and development in the four groups at six-month-old.Of 42 HIE cases, 3 cases were died at early stage, and 9 cases were lost to follow-up.30 cases (22 males and 8 females) were finally followed up at six-month-old and recepted evaluation of growth and development. And among them, 14 cases were normal aEEG, 11 cases were mildly abnormal aEEG and 5 cases were severely abnormal aEEG. All the control cases were followed.2.1 The somatic developmentThe HC ( X±SD) of the control group, the normal aEEG group, the mildly abnormal aEEG group and the severely abnormal aEEG group was 41.2±1.57cm, 41.6±1.21cm, 40.1±1.33cm and 39.6±0.50cm, respectively. There was significant difference among the groups (F=0.09, P<0.05).The further comparison showed: the HC of the infants with severely abnormal aEEG was smaller than others, while there was no significant difference among other three groups.The recumbent length ( X±SD) of the control group, the normal aEEG group, the mildly abnormal aEEG group and the severely abnormal aEEG group was 68.3±1.71cm, 67.6±1.39cm, 67.5±1.99cm and 65.3±4.21cm, respectively. There was no significant difference among the groups (F=1.75, P>0.05).The weight ( X±SD) of the control group, the normal aEEG group, the mildly abnormal aEEG group and the severely abnormal aEEG group was 8.25±0.50kg, 7.86±0.64kg, 7.91±0.89kg and 7.36±0.64kg, respectively. There was no significant difference among the groups (F=3.26, P>0.05).2.2 The neurodevelopmental status2.2.1 The neurodevelopmental scoringBoth the mental developmental index (MI) and the developmental quotient (DQ) were significant difference in the four groups (P<0.001). The MI ( X±SD) of the control group, the normal aEEG group, the mildly abnormal aEEG group and the severely abnormal aEEG group was 93.4±3.17, 91.8±1.39, 88.5±1.99 and 65.2±4.20, respectively. And the DQ ( X±SD) was 92.1±4.25, 92.0±4.53, 88.3±5.56 and 67.4±12.76, respectively. The further comparison showed: both the MI and the DQ in severely abnormal aEEG group were lower than other three groups (P<0.001). And the MI and the DQ were not significant difference among the mildly abnormal aEEG group, the normal aEEG group and the control group.2.2.2 The occurrence of epilepsyIn the control group, the normal aEEG group and the mildly abnormal aEEG, there were no cases suffering with epilepsy. And two cases (40%) in severely abnormal aEEG group were with epilepsy. The occurrence of epilepsy in the severely abnormal aEEG group was higher than other groups (P<0.05).3. The correlation between the categorization of the aEEG and the prognosis in the infants with HIEAmong 33 followers, 14 cases in the normal aEEG group and 9 cases in the mildly abnormal aEEG group were normal outcome. 2 cases in the mildly abnormal aEEG group and 5 cases in the severely abnormal aEEG group were abnormal outcome. And all the three dead cases were severely abnormal aEEG. There was positive correlation between the categorization of aEEG and the prognosis of HIE (r=0.788, P<0.001).Particularly, the prognosis of the neurological was usually poor for the infant who was with the severely abnormal aEEG.Conclusions:1. There was an excellent positive correlation between the categorization of the aEEG and the clinical classification of HIE. The clinical classification of HIE in patient whose categorization of the aEEG was serous was more severe. And usually, the infant, with the severely abnormal aEEG, was often belong to the severe HIE by clinical classification.2. The aEEG was a good prediction for the evaluation of the prognosis in infant with HIE. The prognosis was usually bad in infant whose categorization of the aEEG was severely abnormal.3. The aEEG could be used, in NICU, to diagnose and observe the curative effect of the HIE for the atraumatic and convenient character.4. The development of the nervous system was delayed in infant with the severe HIE all of whose MI, DQ and HC were lower.5. The somatic development in the recumbent length and weight was almost normal in infant with HIE, no matter how severe of the clinical classification was.
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