相对正常的极早产儿生后早期视频脑电图结果分析

Analysis of video-electroencephalography in relatively normal very premature infants

目的探讨极早产儿生后7d内视频脑电图监测的背景活动特点.方法选择2017年6月至2018年4月在北京大学第一医院新生儿重症监护病房住院、胎龄≤31周且在生后7d内完成床旁视频脑电图检查的极早产儿进行回顾性研究,排除头颅影像学严重异常、放弃治疗、死亡或脑电图提示有发作的病例.收集早产儿的基本信息、临床诊断、围生期病史.从脑电图背景活动连续性、睡眠-觉醒周期等方面进行分析.结果共纳入56例,胎龄(29.4±1.6)周,出生体重(1306±316)g;诊断窒息31例,5 min Apgar评分均>5分,脐动脉血气pH 7.29±0.07.所有病例首次头颅超声及校正足月时头颅超声均提示在正常范围,随访至校正6月龄时Gesell评分各项均在正常范围.随着校正胎龄增加,极早产儿脑电图逐渐呈现正常连续/不连续图形.脑电图最长暴发抑制间歇95%置信区间可达95 s.脑电图睡眠-觉醒周期在校正胎龄26周即可出现,但为间断不成熟的睡眠-觉醒周期,随胎龄增加睡眠-觉醒周期逐渐趋于成熟.结论本组相对正常的极早产儿生后1周内视频脑电图提示暴发抑制间歇可能较长,在校正胎龄26周即可出现睡眠-觉醒周期.

Objective To study the video-electroencephalography(vEEG)background activities of very premature infants within the first 7 days after birth.Method The inclusion criteria were gestational age(GA)within 31 weeks and bedside vEEG monitoring within first 7 days of birth.Those with severe cranial ultrasound(CUS)findings,refused treatment,dead and with seizures on vEEG were excluded.The clinical information of included cases were reviewed and the continuity and sleep-wake cycle(SWC)on their EEG background activities were analysed.Result From June 2017 to April 2018,a total of 56 cases were included.Their GA were(29.4±1.6)weeks,and birth weight were(1306±316)g.A total of 31 cases were diagnosed with asphyxia(1 min Apgar score less than 8),and no one with 5 min Apgar score below 5.Their umbilical artery blood pHs were 7.29±0.07.Their first CUS and the CUS at corrected gestational age(cGA)full term were all within the normal range.The Gesell neurological assessment at cGA 6 months were all within the normal range.As the cGA increased,the continuity of EEG background activities became more continuous as the normal continuous/discontinuous pattern.The 95%confidence interval of max interburst interval was 95 s.The SWC first occurred at GA 26 w,but was immature,then became mature as the cGA increased.Conclusion The EEG background activity analysis of relatively normal very premature infants within first week shows that interburst interval can be longer than the previous report,and the SWC first appear at GA 26 w.