The Role Of Amplitude-Integrated Electroencephalography Combined With MRI In Evaluating Neonatal Severe Hyperbilirubinemia

ObjectiveTo investigate the role of aEEG in neonatal severe hyperbilirubinemia by studying amplitude-integrated electroencephalography（aEEG）in neonates with neonatal hyperbilirubinemia.The diagnostic value of aEEG in neonatal severe hyperbilirubinemia was also analyzed in combination with cranial MRI.MethodA total of 240 children with full-term hyperunconjugated bilirubinemia admitted to the neonatal unit of Kunming Children’s Hospital from October 2019 to September 2020 were selected for the study,and the children were divided into the normal group（220μmol/L ≤ TSB < 342 μmol/L）,and the severe group（TSB ≥ 427.5 μmol/L）according to their age and total serum bilirubin（TSB）values at admission.The severe group（342μmol/L ≤ TSB < 427.5 μmol/L）and the very severe group（TSB ≥ 427.5 μmol/L）.All children underwent aEEG monitoring within 48 h after admission,and cranial MRI was completed in children in the severe and very severe groups.The differences in aEEG between the three groups were compared and combined with MRI for diagnostic value analysis to assess the sensitivity and specificity of the two examination methods in the diagnosis of acute bilirubin encephalopathy.Result1.By comparing the general data of the three groups,it was found that the differences in gender,gestational age,birth weight,daytime age,and maternal age were not statistically significant（P > 0.05）.The differences in time of onset and hospitalization were statistically significant（P < 0.05）.2.By comparing the biochemical data of the three groups,it was found that alanine aminotransferase,aspartate aminotransferase and serum albumin were not statistically significant（P > 0.05）.Serum total bilirubin and B/A ratio,were statistically significant（P < 0.05）.3.By comparing the etiology of hyperbilirubinemia in the three groups,it was found that abnormal thyroid function and unknown etiology were not statistically significant（P >0.05）.Blood group incompatibility hemolytic disease,infection and G6 PD deficiency were statistically significant（P < 0.05）.4.The abnormality rate of aEEG was 23.0% in the normal group,37.7% in the severe group,and 44.1% in the very severe group.Combined with the Burdjalov scale,the scores were 11.0（1.0）in the normal group,10.0（2.0）in the severe group,and 9.0（2.0）in the very severe group,all with statistically significant differences（P < 0.05）.5.aEEG assessment of acute bilirubin encephalopathy had a sensitivity of 48.4%and a specificity of 80.0%.The sensitivity of cranial MRI for assessing acute bilirubin encephalopathy was 94.7% and the specificity was 53.3%.aEEG combined with MRI for assessing acute bilirubin encephalopathy had a sensitivity of 100% and a specificity of48.9%.The diagnostic value was analyzed by means of the receiver operating characteristic（ROC）map,and the area under the curve（AUC）and 95% confidence interval（CI）were also calculated.The AUC for both assessment instruments: 0.642 for aEEG,0.740 for MRI,and 0.744 for aEEG combined with MRI.95% CI for both assessment instruments: 0.547-0.737 for aEEG,0.642-0.838 for MRI,and 0.645-0.844 for aEEG combined with MRI.Conclusion1.The higher the serum total bilirubin level,the higher the rate of aEEG abnormality,mainly manifested as delayed sleep cycle maturation.2.The specificity of aEEG in assessing acute bilirubin encephalopathy is higher than that of cranial MRI,while the sensitivity is lower than that of cranial MRI.However,aEEG combined with cranial MRI can improve the accuracy of the diagnosis of acute bilirubin encephalopathy,help to detect brain injury at an early stage,timely intervention and treatment,and reduce the occurrence of sequelae.