振幅整合脑电图对新生儿低血糖脑损伤患儿的脑功能监测意义

目的 探讨振幅整合脑电图(amplitude integrated electroencephalography,aEEG)在新生儿低血糖脑损伤急性期的改变以及其与疾病预后的相关性.方法 研究纳入2011年1月至2015年7月泉州市儿童医院新生儿重症监护室收治的47例新生儿低血糖脑损伤患儿.记录患儿的临床资料和治疗转归;采用aEEG进行脑功能监测;采用首都儿科研究所《0~6岁小儿神经心理发育检查表》进行患儿生后6月龄智能评估;分析aEEG背景活动分类,癫痫性电活动,睡眠觉醒周期,异常程度等参数与新生儿低血糖脑损伤患儿近期临床预后的相关性.结果 急性期aEEG波形:连续正常电压9例,不连续电压29例,连续低电压3例,爆发抑制6例;39例(83.0%)患儿记录到癫痫性电活动:单次惊厥、反复惊厥、惊厥持续状态分别为:11例、20例、8例;睡眠觉醒周期:无21例,不成熟17例,成熟9例.aEEG异常程度判定:正常7例,轻度异常9例,重度异常31例,其中重度异常中23例预后不良,包括死亡3例及随访至生后6月龄智能发育商≤69者20例.aEEG背景活动、睡眠觉醒周期分类以及aEEG异常程度与患儿临床近期预后通过双向有序等级相关性分析提示存在相关性(r=0.714、0.696、0.746,均P<0.001).结论 aEEG可以用于评估新生儿低血糖脑损伤患儿临床脑功能损伤严重程度及近期预后,是其脑功能监测的有用工具.     

Early single-channel aEEG/EEG predicts outcome in very preterm infants

Aim: To characterize early amplitude‐integrated electroencephalogram (aEEG) and single‐channel EEG (aEEG/EEG) in very preterm (VPT) infants for prediction of long‐term outcome. Patients: Forty‐nine infants with median (range) gestational age of 25 (22–30) weeks. Methods: Amplitude‐integrated electroencephalogram/EEG recorded during the first 72 h and analysed over 0–12, 12–24, 24–48 and 48–72 h, for background pattern, sleep–wake cycling, seizures, interburst intervals (IBI) and interburst percentage (IB%). In total, 2614 h of single‐channel EEG examined for seizures. Survivors were assessed at 2 years corrected age with a neurological examination and Bayley Scales of Infant Development‐II. Poor outcome was defined as death or survival with neurodevelopmental impairment. Good outcome was defined as survival without impairment. Results: Thirty infants had good outcome. Poor outcome (n = 19) was associated with depressed aEEG/EEG already during the first 12 h (p = 0.023), and with prolonged IBI and higher IB% at 24 h. Seizures were present in 43% of the infants and associated with intraventricular haemorrhages but not with outcome. Best predictors of poor outcome were burst‐suppression pattern [76% correctly predicted; positive predictive value (PPV) 63%, negative predictive value (NPV) 91%], IBI > 6 sec (74% correctly predicted; PPV 67%, NPV 79%) and IB% > 55% at 24 h age (79% correctly predicted; PPV 72%, NPV 80%). In 35 infants with normal cerebral ultrasound during the first 3 days, outcome was correctly predicted in 82% by IB% (PPV 82%, NPV 83%). Conclusion: Long‐term outcome can be predicted by aEEG/EEG with 75–80% accuracy already at 24 postnatal hours in VPT infants, also in infants with no early indication of brain injury.     

振幅整合脑电图监测不同胎龄早产儿宫外环境下脑发育的多中心观察性研究

目的 了解宫外生活对28~36周早产儿振幅整合脑电图（aEEG）的影响。方法 以出生时无窒息抢救史早产儿为早产儿组,以胎龄37周出生后正常的新生儿为对照组;早产儿组采用振幅整合脑电图仪分别于生后3 d内,然后每周监测1次直至出院（或最长监测至纠正胎龄37周）,对照组于生后第3 d 行aEEG监测。每次连续监测4 h。分析胎龄和纠正胎龄对aEEG成熟过程影响,包括aEEG背景连续性、睡眠-觉醒周期、下边界振幅和带宽。5家参研医院均采用相同品牌和型号的aEEG,研究开始前统一进行操作技术培训,样本的临床和图像数据发送至复旦大学附属儿科医院整理。结果 2008年5月1日至2009年8 月31日5家参研医院符合本文纳入和排除标准的早产儿组135例,对照组20例。早产儿aEEG的成熟度受胎龄和纠正胎龄的影响,随胎龄和纠正胎龄增加,aEEG背景连续性和睡眠-觉醒周期出现的百分比均增加,逐步出现连续性电压（χ2=26.865,P<0.01）,≥34周出生的早产儿成熟的睡眠-觉醒周期的出现的百分比均为100％（χ2=192.4,P<0.01）;下边界振幅升高（F＝11.4,P<0.01）,带宽变窄（F＝8.731,P<0.01）。纠正胎龄和同出生胎龄的新生儿比较,连续性电压百分比、睡眠-觉醒周期的出现率均显著增加,胎龄＞34周的早产儿出生时aEEG均可见明显的睡眠-觉醒周期,而纠正胎龄32周时,睡眠-觉醒周期出现的百分比已达到100%;窄带下界也显著增高;窄带带宽变窄,至34周龄后,纠正胎龄和同出生胎龄新生儿均变化不明显。结论 早产儿aEEG的成熟度与出生胎龄和纠正胎龄相关,宫外生活加速了早产儿脑发育成熟。     

The prognostic value of amplitude integrated EEG in neonatal sepsis and/or meningitis

Aim: To investigate the longitudinal course and prognostic value of amplitude integrated EEG (aEEG) in infants with neonatal sepsis or meningitis. Methods: Amplitude integrated EEG recordings of 22 infants with sepsis/meningitis were retrospectively evaluated. Mean gestational age was 38 weeks (range: 34–42 weeks). Thirteen infants had meningitis. Survivors were seen for neurological follow‐up. Four infants died, two were severely abnormal at 24 months. Amplitude integrated EEG background pattern, sleep wake cycling (SWC) and electrographic seizure activity (EA) were appraised. Results: All infants with continuous low voltage or flat trace on aEEG (n = 4) had an adverse outcome. Low voltage aEEGs (n = 9) had a positive LR (LR+) for an adverse outcome of 5.3 (95% CI: 1.9–14.8) at 6 h and 8.3 (95% CI: 1.3–55) at 24 h after admission. EA was more frequent in infants with adverse outcome (p < 0.01) and had a LR+ for adverse outcome of 10.6 (95% CI: 1.5–76). SWC appeared more frequent in infants with good outcome (p < 0.05). Conclusion: Low voltage background pattern, SWC and EA on aEEG are helpful to predict neurological outcome in infants with neonatal sepsis or meningitis.     

早产儿振幅整合脑电图的应用

振幅整合脑电图是脑电图技术的一种简化形式,近年来已被证实可以辅助诊断足月儿缺血缺氧性脑病、预测窒息后足月儿神经发育结局,但对于早产儿应用较少.早产儿振幅整合脑电图与脑发育成熟程度相关,易受临床干预措施等多种因素影响,目前诸多研究者认为早产儿振幅整合脑电图同样有助于早产儿脑损伤诊断及神经发育结局预测.该文从早产儿振幅整合脑电图与脑发育的关系、影响因素,对脑损伤诊断价值及神经发育结局预测能力角度进行综述.     

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??Amplitude integrated EEG??aEEG??is derived from limited channels ??usually P3-P4 or C3-P3??C4-P4?? and is filtered??rectified and time-compressed to serve as a real-time??noninvasive??bedside cerebral function monitoring. It’s simple application and interpretation has resulted in increasing use in neonatal intensive care units across the world. Current evidence demonstrates that aEEG is useful to monitor cerebral background activity??diagnose and treat seizures and predict neurodevelopmental outcomes for preterm and term infants. Validation investigation with full array EEG have shown reliable results in interpretation of cerebral electric background and electrographic seizures??especially when used with the simultaneously displayed raw EEG trace.     

Amplitude-integrated EEG differences in premature infants with and without bronchopulmonary dysplasia: a cross-sectional study

Aim: To evaluate differences in amplitude‐integrated electroencephalogram (aEEG) recordings of infants with and without bronchopulmonary dysplasia (BPD). Methods: This is a cross‐sectional study of infants ≤27 weeks at birth who did (n = 17) or did not develop BPD (n = 17). aEEG tracings were recorded at 36⁰–36⁶ weeks post‐menstrual age for 6 h using the BrainZ BRM3 monitor. A cross‐cerebral channel was evaluated using offline software Analyze (BrainZ). Results: Infants with BPD had lower gestational age and higher male predominance (25 ± 1 weeks, 70%) compared with non‐BPD infants (26 ± 1 weeks, 30%, all p ≤ 0.03), but similar birth weight (704 ± 195 vs. 796 ± 167 g, p = 0.1). During active sleep, infants with BPD had wider span voltage (p = 0.03), higher lower border voltage (p < 0.03), as well as less periods of quiet sleep per hour (p < 0.01) compared with non‐BPD infants. These differences persisted after adjustment for covariates. Conclusion: Infants with BPD have small but significant differences in their aEEG tracings compared with infants without BPD at 36 weeks. Further study of infants with BPD using aEEG appears justified to determine whether aEEG variables correlate with neurodevelopmental outcome.     

Early amplitude integrated electroencephalography and outcome of very low birth weight infants

Objective: Amplitude integrated electroencephalography (aEEG) has been used in neonates in various clinical and research applications. We hypothesized that an abnormal aEEG score could be used as a predictor of short‐term adverse outcome. Methods: Very low birth weight infants were enrolled in a prospective observational cohort study. Two channel 12‐hour continuous aEEG recordings were performed within 48 h of life and at 1 week of age. Recordings were classified as abnormal if they correspond to a 2 point difference in score. Short‐term adverse outcome was defined as either death or Bayley scales ≤70 at 4 months corrected age. Results: One hundred infants were enrolled. Their average gestational age was 27.9 ± 2.6 weeks and average birth weight was 997 ± 299 gram. Fifteen enrolled infants died, one was withdrawn, 29 lost to follow up, and 55 examined at 4 months. Those with adverse outcome had significantly increased percentages of abnormal EEG at 1 week of life (31% vs. 8%), severe intraventricular hemorrhage (IVH) (27% vs. 4.5%), intubation in the delivery room (45% vs. 16%), and increased average days of mechanical ventilation (16 days vs. 4 days). Combining abnormal aEEG at 1 week of life to severe IVH on early head ultrasound increased the sensitivity of ultrasound to detect short‐term adverse outcome from 27% to 50%. Conclusion: aEEG is feasible in premature infants and when its data at 1 week of life are combined with early head ultrasound, sensitivity for detecting short‐term adverse outcomes was increased.     

Amplitudenintegriertes Elektroenzephalogramm

Every year about 15 million babies are born preterm and 1 in 12 infants were born preterm in Austria in 2011. Despite tremendous efforts in obstetrical and neonatal care, preterm birth rates have further increased during the last 30 years. At present preterm birth is the leading cause of neonatal death and the second most common cause of death in children aged below 5 years. In general, complications following preterm birth arise from the biological immaturity of the organ systems. It must be born in mind that the first year of life is the most dynamic phase of postnatal brain development. In recent years imaging studies have contributed valuable information to the knowledge on brain maturation and developing brain injury. Amplitude-integrated electroencephalogram (aEEG) has been used to continuously monitor electrocortical activity in newborns for more than 30 years. In recent years aEEG has also been extensively studied in preterm neonates which is reflected by the growing number of studies being published. The advantages of aEEG over other diagnostic tools appear to be manifold; therefore, aEEG monitors are now increasingly being used in neonatal intensive care units. Continuous monitoring of electrocortical activity allows close evaluation of brain function, ongoing analysis of maturational processes and developmental plasticity. Additionally, in preterm infants brain activity recorded within the first days after birth serves as the closest estimate of intrauterine electrocortical function. The aEEG completes the panel on instruments to monitor vital organ function during intensive care and is also available for the smallest patients.     

Amplitude-integrated electroencephalographic changes in a newborn induced by overdose of morphine and corrected with naloxone

The amplitude-integrated electroencephalogram (aEEG) is a useful tool to assess brain function after perinatal asphyxia in term infants. We report a full-term newborn with moderate perinatal asphyxia, who accidentally received an overdose of morphine (5000 microg/kg). The overdose of morphine resulted in a clear and immediate change of aEEG background activity from a continuous (C) to discontinuous (DC) background pattern. After administration of naloxone, the background activity restored immediately to continuous background pattern. The aEEG was used to monitor the stepwise reduction in continuous naloxone infusion. CONCLUSION: An overdose of morphine leads to clear and immediate changes in aEEG which restore after naloxone treatment. The aEEG can be used to monitor naloxone infusion.     

Music exposure and maturation of late preterm sleep–wake cycles: a randomised crossover trial

Aim

To determine the effect of music on sleep–wake cycle (SWC) patterns in late preterm neonates.

Methods

In a masked crossover study, infants between 32 and 36 6/7 weeks gestation were randomised to music exposure either during the first six or last six hours of a 12‐hour observation period. SWC characteristics were determined by continuous amplitude‐integrated electroencephalography (aEEG) read by two coders masked to exposure sequence. Analysis was performed in paired comparisons. ANOVA was used to assess the effects of music exposure, period and crossover on SWC outcomes: (i) Burdjalov Scores (BS) during active sleep (AS) (ii) per cent and duration of quiet sleep (QS).

Results

Thirty infants were studied. A total of 222 QS cycles (median seven per patient; range five to 12) were analysed. Music exposure was associated with higher BS (F = 10.60, p = 0.0019) in AS and decreased interruptions during QS. The advanced postconceptual age (PCA) SWC pattern during AS was equivalent to a one‐week mean. Number, duration and ratio of QS cycles did not change with music exposure.

Conclusion

Music exposure elicits an increasing PCA pattern in AS and fewer interruptions in QS. Music may benefit sleep in late preterm infants.     

振幅整合脑电图对早产儿脑损伤的诊断价值及其影响因素

目的　探讨振幅整合脑电图(aEEG)对早产儿脑损伤(BIPI)的诊断价值及其影响因素。方法　将116例胎龄27~36+6周早产儿纳入研究, 对所有早产儿生后 6 h 内aEEG进行评分; 依据BIPI诊断结果将116例早产儿分为BIPI组(n=63)和非BIPI组(n=53), 采用logistic回归分析对导致BIPI发生的危险因素进行评估; 依据aEEG检测结果再将116例早产儿分为aEEG正常组(n=58)和aEEG异常组(n=58), 对影响早产儿aEEG结果的因素行单因素分析。结果　BIPI组中aEEG异常52 例(83%); 非BIPI组中aEEG 异常6例(11%), 两组aEEG异常率比较差异有统计学意义(P<0.05)。将早产儿依据胎龄27~33+6周和34~36+6周进行划分, BIPI组aEEG评分明显低于同胎龄非BIPI组(P<0.01)。Logistic回归分析显示：小胎龄(<32周)、低出生体重(<1 500 g)、胎盘胎膜及脐带异常和母孕期高血压是导致BIPI发生的高危因素(P<0.05)。aEEG异常组与aEEG正常组在胎龄、出生体重、胎盘胎膜及脐带异常和母孕期高血压4方面比较差异有统计学意义(P<0.05)。结论 导致BIPI发生的危险因素与影响早产儿aEEG结果的因素相一致, 提示aEEG有助于BIPI的早期诊断。     

Electroencephalography in neonatal epilepsies

Neonatal epilepsies – neonatal seizures caused by remote symptomatic etiologies – are infrequent compared with those caused by acute symptomatic etiologies. The etiologies of neonatal epilepsies are classified into structural, genetic, and metabolic. Electroencephalography (EEG) and amplitude‐integrated EEG (aEEG) are essential for the diagnosis and monitoring of neonatal epilepsies. Electroencephalography / aEEG findings may differ substantially among infants, even within infants with variants in a single gene. Unusual EEG/aEEG findings, such as downward seizure patterns on aEEG, can be found. Neonatal seizures are exclusively of focal onset. An International League Against Epilepsy task force proposed that the seizure type is typically determined by the predominant clinical feature and is classified into motor or non‐motor presentations. Ictal EEG usually demonstrates a sudden, repetitive, evolving, and stereotyped activities with a minimum duration of 10 s. In epileptic spasms and myoclonic seizures, the cut‐off point of 10 s cannot be applied. One must always be aware of electro–clinical dissociation in neonates suspected to have seizures. Amplitude‐integrated EEG is also useful for the diagnosis and monitoring of neonatal epilepsies but aEEG cannot be recommended as the mainstay because of its relatively low sensitivity and specificity. At present, EEG findings are not pathognomonic, although some characteristic ictal or interictal EEG findings have been reported in several neonatal epilepsies. Deep learning will be expected to be introduced into EEG interpretation in near future. Objective EEG classification derived from deep learning may help to clarify EEG characteristics in some specific cases of neonatal epilepsy.     

振幅整合脑电图联合头颅磁共振定量指标对中晚期早产儿近期神经发育预测价值的前瞻性研究

目的 探讨振幅整合脑电图（amplitude-integrated electroencephalogram,aEEG）、头颅磁共振成像（cranial magnetic resonance imaging,cMRI）的定量指标双顶径（biparietal width,BPW）、两半球间距（interhemispheric distance,IHD）与中晚期早产儿近期神经发育的关系。 方法 前瞻性选择2018年9月至2020年4月入住新生儿重症监护病房的104例中晚期早产儿为研究对象,在生后72 h内采用Naqeeb法及睡眠-觉醒周期（sleep-wake cycling,SWC）进行aEEG评估;在矫正胎龄37周时完成cMRI检查,并在T2冠状位测量BPW和IHD;矫正月龄6月龄时采用0~6岁儿童发育筛查测验（Developmental Screening Test for Child Under Six,DST）随访神经发育,并根据发育商（development quotient,DQ）分为DST正常组（≥85分,78例）和DST异常组（DQ<85分,26例）,分析比较两组间各指标差异,以及aEEG和cMRI的关系。 结果 DST异常组aEEG正常率、SWC成熟率低于DST正常组（P<0.05）;与DST正常组相比,DST异常组的IHD偏大、BPW偏小（P<0.05）。不成熟的SWC、aEEG异常、较大的IHD是DST异常的危险因素（P<0.05）,较大的BPW是DST异常的保护因素（P<0.05）。 结论 中晚期早产儿生后72 h内的aEEG、矫正胎龄37周时cMRI定量指标BPW和IHD可能影响其矫正月龄6月龄时的神经发育结局。     

The influence of extrauterine life on the aEEG maturation in normal preterm infants

Objective

To study, the maturational changes of the amplitude-integrated electroencephalogram (aEEG) in preterm infants without neurological disorders and especially the influence of the duration of extrauterine life, over this process.

Methods

96 preterm infants, 25-34 weeks' gestational age (GA) at birth, clinically stable and without ultrasonographic evidence of neurological abnormalities, were studied. The aEEG recordings were obtained within 72 h of life and then weekly until discharge. Four aspects of each tracing (continuity, sleep-wake cycling, bandwidth, and lower border), were evaluated by visual analysis, applying pre-established criteria.

Results

We analysed 624 aEEG recordings at postmenstrual age (PMA) of 25-42 weeks. With advanced GA the aEEG becomes more continuous (p: 0.022), it displays definite sleep-wake cycles (p: 0.011), and its bandwidth acquires the mature pattern (p: 0.012). A positive significant interaction of GA and PMA in the evolution of aEEG was found regarding continuity (p: 0.002), sleep-wake cycling (p: 0.002), and bandwidth (p: 0.02).

Conclusion

The evolution of the aEEG tracing depends on both GA and PMA. The older the infants at birth the more mature the aEEG pattern. At the same PMA, preterm infants of lower GA display an advanced maturation of the aEEG comparing with others of higher GA.     

The influence of phenobarbital overdose on aEEG recording

Monitoring infants with amplitude integrated electroencephalography (aEEG) in neonatal units is becoming widespread. A case of a preterm infant who was monitored with aEEG due to suspected seizures is presented. The case emphasizes both the usefulness and drawback of aEEG. An erroneous diagnosis of seizure lead to phenobarbital overdose and the change of aEEG voltage and pattern assisted in a prompt diagnosis.     

Early amplitude-integrated EEG correlates with cord TNF-α and brain injury in very preterm infants

Aim: To investigate if the early electroencephalogram (EEG) and amplitude-integrated EEG (aEEG) in very preterm infants is affected by perinatal inflammation and brain injury, and correlates with long-term outcome.
Methods: Sixteen infants born at 24–28 gestational weeks (median 25.5) had continuous EEG/aEEG during the first 72 h of life. Minimum and maximum EEG interburst intervals (IBI), and aEEG amplitudes were semi-automatically quantified and averaged over the recording period. Neonatal brain injury was diagnosed with repeated cranial ultrasound investigations. Nine cytokines from four time-points were analyzed during the first 72 h (umbilical cord blood, 6, 24 and 72 h), and outcome was assessed at 2 years of corrected age.
Results: Infants with neonatal brain injury (n = 9) had prolonged IBI, 11.8 (9.6–23.2) sec versus 8.2 (7.1–11.6) sec in infants (n = 7) without brain damage (p = 0.005). Handicap at 2 years (n = 8, including two infants without neonatally diagnosed brain injury) was associated with prolonged neonatal IBI and lower aEEG amplitudes. Also aEEG amplitudes were decreased in infants with neonatal brain injury. There was a significant positive correlation between the averaged IBI and cord blood TNF-α (rs = 0.595, p = 0.025).
Conclusion: Early EEG depression is associated with increased cord blood TNF-α, neonatal brain damage and handicap at 2 years.     

Amplitude integrated EEG 3 and 6 hours after birth in full term neonates with hypoxic-ischaemic encephalopathy.

AIM: To assess the prognostic value of amplitude integrated EEG (aEEG) 3 and 6 hours after birth. METHODS: Seventy three term, asphyxiated infants were studied (from two different centres), using the Cerebral Function Monitor (CFM Lectromed). The different aEEG tracings were compared using pattern recognition (flat tracing mainly isoelectric (FT); continuous extremely low voltage (CLV); burst-suppression (BS); discontinuous normal voltage (DNV); continuous normal voltage (CNV)) with subsequent outcome. RESULTS: Sixty eight infants were followed up for more than 12 months (range 12 months to 6 years).Twenty one out of 68 infants (31%) showed a change in pattern from 3 to 6 hours, but this was only significant in five cases (24%). In three this changed from BS to CNV with a normal outcome. One infant showed a change in pattern from CNV to FT and had a major handicap at follow up. Another infant showed a change in pattern from DNV to BS, and developed a major handicap at follow up. The other 16 infants did not have any significant changes in pattern: 11 infants had CLV, BS, or FT at 3 and 6 hours and died (n = 9) in the neonatal period or developed a major handicap (n = 2). Five infants had a CNV or DNV pattern at 3 and 6 hours, with a normal outcome. The sensitivity and specificity of BS, together with FT and CLV, for poor outcome at 3 hours was 0.85 and 0.77, respectively; at 6 hours 0.91 and 0.86, respectively. The positive predictive value (PPV) was 78% and the negative predictive value (NPV) 84% 3 hours after birth. At 6 hours the PPV was 86% and the NPV was 91%. CONCLUSION: aEEG could be very useful for selecting those infants who might benefit from intervention after birth asphyxia.     

Early amplitude-integrated EEG correlates with cord TNF-alpha and brain injury in very preterm infants.

AIM: To investigate if the early electroencephalogram (EEG) and amplitude-integrated EEG (aEEG) in very preterm infants is affected by perinatal inflammation and brain injury, and correlates with long-term outcome. METHODS: Sixteen infants born at 24-28 gestational weeks (median 25.5) had continuous EEG/aEEG during the first 72 h of life. Minimum and maximum EEG interburst intervals (IBI), and aEEG amplitudes were semi-automatically quantified and averaged over the recording period. Neonatal brain injury was diagnosed with repeated cranial ultrasound investigations. Nine cytokines from four time-points were analyzed during the first 72 h (umbilical cord blood, 6, 24 and 72 h), and outcome was assessed at 2 years of corrected age. RESULTS: Infants with neonatal brain injury (n=9) had prolonged IBI, 11.8 (9.6-23.2) sec versus 8.2 (7.1-11.6) sec in infants (n=7) without brain damage (p=0.005). Handicap at 2 years (n=8, including two infants without neonatally diagnosed brain injury) was associated with prolonged neonatal IBI and lower aEEG amplitudes. Also aEEG amplitudes were decreased in infants with neonatal brain injury. There was a significant positive correlation between the averaged IBI and cord blood TNF-alpha (rs=0.595, p=0.025). CONCLUSION: Early EEG depression is associated with increased cord blood TNF-alpha, neonatal brain damage and handicap at 2 years.     

早产儿振幅整合脑电图的影响因素

目的探讨早产儿振幅整合脑电图(aEEG)的影响因素。方法在出生12 h内采用NicoletOne脑功能监测仪对71例早产儿进行aEEG描记。根据aEEG背景活动的方式及有无惊厥样活动,将aEEG结果判断为正常和异常aEEG(包括轻度异常及重度异常)。床旁颅脑超声监测脑损伤的发生。分析胎龄、出生体质量、窒息、低氧血症、辅助通气及脑损伤对早产儿aEEG的影响。结果 1.早产儿71例中,正常aEEG 40例,异常aEEG 31例。2.胎龄<34周者54例,正常aEEG 25例,异常aEEG 29例(53.7%);≥34周者17例,正常aEEG 15例,异常aEEG 2例(11.8%);2组aEEG异常率比较差异有统计学意义(χ2=9.245 2,P<0.01)。3.出生体质量<1.5 kg者25例,正常aEEG 8例,异常aEEG 17例(68.0%);出生体质量≥1.5 kg者46例,正常aEEG 32例,异常aEEG14例(30.4%);2组aEEG异常率比较差异有统计学意义(χ2=9.291 9,P<0.001)。4.产时有窒息者36例,正常aEEG 15例,异常aEEG 21例(58.3%);无窒息者35例,正常aEEG 25例,异常aEEG 10例(28.6%);2组aEEG异常率比较差异有统计学意义(χ2=6.390 4,P<0.05)。5.低氧血症24例,正常aEEG 16例,异常aEEG 8例(33.3%);无低氧血症者47例,正常aEEG 24例,异常aEEG 23例(48.9%);2组aEEG异常率比较差异无统计学意义(χ2=1.572 4,P>0.05)。6.辅助通气者19例,正常aEEG 8例,异常aEEG 11例(57.9%);未辅助通气者52例,正常aEEG 32例,异常aEEG 20例(38.5%);2组aEEG异常率比较差异无统计学意义(χ2=2.136 4,P>0.05)。7.有脑损伤者51例,正常aEEG 24例,异常aEEG 27例(52.9%);无脑损伤者20例,正常aEEG 16例,异常aEEG 4例(20.0%);2组aEEG异常率比较差异有统计学意义(χ2=6.337 5,P<0.05)。结论胎龄和出生体质量对早产儿aEEG有显著影响。小胎龄、低出生体质量以及出生时窒息和脑损伤的早产儿异常aEEG的发生率高。在分析早产儿aEEG时应考虑胎龄、出生体质量、窒息及脑损伤等生理病理因素的影响。