Application Of Amplitude Integrated Eeg For Brain Injury And Brian Development Tor Braln Injury And Brian Development In Preterm Infants With Asphyxia In Preterm Infants With Asphyxia

Objective:1.The normal preterm infants with different gestational age were dynamic monitored by amplitude integrated EEG(aEEG) and followed up to12months of age correction. We aimed to observe and analyse the relationship between the characteristics of aEEG and gestational age and brain development.2. We investigated the relationship between the characteristics of aEEG and brain damage and neurodevelopmental outcomes, and explored the predictive value of aEEG monitoring to the neurodevelopmental outcome.Methods486cases of preterm infants who were born in March2009to May2012and hospitalized in the NICU in Hangzhou First People’s hospital, were included and followed up to12months of corrected age.There were306normal preterm infants and180preterm infants with asphyxia(105cases with mild asphyxia and75cases with severe asphyxia).They were divided three groups by gestational age of<30weeks,30～33weeks and>33weeks. The preterm infants enrolled into the study were monitored by amplitude integrated EEG(aEEG) at6～8hours after birth for the first time, and then monitored at PNA72h, PNA6d again, and monitored every week after PNA1W untill discharged from hospital.They also were monitored by aEEG for4～6h at PCA40W、CA3months、6months、12months again.The aEEG trace characteristics were classificated interpreted according to different background model and periodic mode. The infant’s neurobehavioral development were scaled by using Neonatal Behavioral Neurological Assessment (NBNA) at PCA40W and Bayley Scales of Infant Development (city version)(BSID) at CA3m、CA6m、CA12m. We analysed neurodevelopmental outcomes and aEEG features of the preterm infants.Results(1)Neurodevelopmental outcome:There is no cases of death at the endpoint, there were8cases of cerebral palsy in normal group, and17cases of cerebral palsy in asphyxia group. It was statistically significant (P<0.05), but there was no difference found between mild asphyxia group and severe asphyxia group (P>0.05). The difference of NBNA、MDI and PDI at different time of follow-up between normal group, mild asphyxia group and severe asphyxia group was statistically significant (P<0.05). The average scors of NBNA. MDI and PDI of two asphyxia groups were lower than that of normal group (P<0.05), and the severe asphyxia group was more significant (P<0.01). But there was no significance between mild asphyxia group and severe asphyxia group (P>0.05)The difference of NBNA between different GA groups at PCA40W were statistically significant (P<0.05), and the scors of GA<30W group were lowest. The scors of NBNA become higher while CA growing. The average scors of MDI and PDI become higher while CA at the time of CA3m、CA6m、CA12m. The average scors of GA>33W group were significantly higher than GA<30W. group(P<0.05).There were significant difference of the incidence of cerebral palsy in different GA groups (P<0.05), and it decreased with GA growth.(2)The Monitoning of aEEG at different age after birth in normal preterm infants:The background of aEEG and SWC were changed rapidly in2weeks after birth, and incidence of abnormal background and no SWC were decreased with GA growth. The difference between PNA6h、72h and PNA6d was statistically significant (P<0.05), and the difference between PNA6d and PNA2W was also statistically significant (P<0.05) in GA<30W group. But there were no significance between PA2W and CA40W in three groups (P>0.05)The incidences of abnormal background and no SWC were more in GA30～33W and GA>33groups than GA<30W group at PNA6h、PNA72h、PNA6d、PNA2W. The difference was statistically significant (P<0.05), and the difference between GA30～33W and GA>33groups was also significant (P<0.05). But there was no significance in three groups at PCA40W (P>0.05)(3)The monitoning of aEEG at different age after birth in asphyxia preterm infants:The background of aEEG and SWC was changed rapidly in2weeks after birth, and incidence of abnormal background and no SWC were decreased with GA growth. The difference between PNA6h、PNA72h、PNA6d and PNA2W was statistically significant (P<0.05), the difference between PNA2W and PCA40W was also statistically significant (P<0.05) in GA<30W group. But there were no significance between PNA2W and PCA40W in GA30～33W and GA>33groups (P>0.05).In the asphyxia groups, the incidence of abnormal background of aEEG and SWC in mild and severe asphyxia group was more than normal preterm infants at PNA6h、 PNA72h、PNA6d、PNA2W, and the difference was statistically significant (P<0.05).It was also statistically significant between mild and severe asphyxia groups (P<0.05).There were no significance in three groups at PCA40W (P>0.05)(4)Predictive value of neurodevelopmental outcome by background mode of aEEG in asphyxia preterm infants:The background of aEEG and SWC was changed rapidly after birth, and the variation was also obvious after PNA2W in GA<30W preterm infants in asphyxia group. However, it was stable from PNA2W to PCA40W in GA30～33W and GA>33W preterm infants in asphyxia groups. Discontinuous normal voltage and mature SWC predict good neurodevelopmental outcome. There was association between the characteristics of aEEG at PNA6h、PNA72h、PNA6d and neurodevelopmental outcome in preterm infants with asphyxia(P<0.05). The characteristics of aEEG at PNA72h and PNA6d was highly correlated with neurodevelopmental outcome. The sensitivity and negative prediction value were decreased, while specificity and positive prediction value increased for the aEEG prediction to neurodevelopmental outcome with the age increasing.Conclusion(1) The maturity of aEEG background and SWC were related to gestational age in normal preterm infants2weeks after birth. And it changes very quickly. With gestational age growth, the aEEG background become more mature characterized by continuous normal voltage and mature SWC.(2)aEEG dynamic Monitroing displayed that the background and SWC of aEEG early after birth (2weeks) in preterm infants with asphyxia had a similar trend to that of normal preterm infants. The abnormal background and no SWC of aEEG were increased in preterm infants with asphyxia at the same time of monitoring sites.(3)Monitoring aEEG at PNA6h. PNA72h、PNA6d was positive associated with neurodevelopmental outcome. It was important in the selection of neuroprotective effects treatment strategy in preterm infants with asphyxia.