振幅整合脑电图在新生儿化脓性脑膜炎神经发育结局中的预测价值

Predictive value of amplitude integrated electroencephalogram inneurological development outcomes of neonatal purulent meningitis

目的通过监测足月新生儿化脓性脑膜炎患儿的振幅整合脑电图(aEEG),分析aEEG的特点,监测患儿神经发育情况,探讨aEEG在足月新生儿化脓性脑膜炎神经发育结局中的预测价值。方法选取2013年1月至2018年6月在嘉兴市妇幼保健院新生儿科住院并确诊为化脓性脑膜炎的足月新生儿80例,全部病例在确诊后24小时内完成aEEG检查,并在出生6个月进行婴儿神经系统国际测验量表(Infanib)评估,在出生12个月时行神经系统检测和Gesell发育量表评估,将其作为诊断的"金标准"。结果患儿出生6个月Infanib评估显示,51例正常,16例过渡,13例异常,与aEEG不同结果的三组对比,差异有统计学意义(Z_C=67.27,P<0.01);患儿出生12月行Gesell发育量表5项指标的评估,并与aEEG不同结果的三组对比,差异有统计学意义(F值分别为5.69,6.13,5.72,5.71,6.87,均P<0.05);出生12月脑瘫的评估,与aEEG不同结果的三组对比,差异均有统计学意义(Z_C=183.40,P<0.01);aEEG的敏感度、特异度、阳性预测值、阴性预测值分别为73.3%、80.0%、68.8%、83.3%;Infanib评估分别为76.7%、88.0%、79.3%、86.3%,aEEG和Infanib评估的敏感度、特异度、阳性预测值、阴性预测值比较差异无统计学意义(χ~2值分别为0.09,1.19,0.88,0.17,均P>0.05)。结论 aEEG检查结果在新生儿化脓性脑膜炎神经发育结局中具有较大的预测价值,其异常提示患儿预后不良,可以早期发现脑损伤。

Objective To analyze the characteristics of aEEG and the neurological development status of full-term neonates with purulent meningitis by monitoring the amplitude-integrated electroencephalography(aEEG),and to explore the predictive value of aEEG in the neurological development outcomes of full-term neonates with purulent meningitis.Methods From January 2013 to June 2018,80 full-term neonates with purulent meningitis were hospitalized in the Department of Neonatology,Jiaxing Maternal and Child Health Care Hospital.All cases completed aEEG examination within 24 hours after diagnosis,and were evaluated by Infant Neurological Battery(Infanib) at 6 months of birth.Nervous system was performed at 12 months of birth.Detection and evaluation of Gesell Development Scale were used as the "gold standard" for diagnosis.Results Infanib evaluation showed that 48 cases were normal,16 cases were transitional,13 cases were abnormal.There was significant difference among the three groups with different results of aEEG(Z_C=67.27,P<0.01).Gesell development scale was used to evaluate the 12-month-old children,and there was no significant difference among the three groups with different results of aEEG(F=5.69,6.13,5.72,5.71 and 6.87,respectively,all P<0.05).There were significant differences in the evaluation of cerebral palsy in December of birth compared with the three groups with different results of aEEG(Z_C=183.40,P<0.01).The sensitivity,specificity,positive predictive value and negative predictive value of aEEG were 73.3%,80.0%,68.8%,83.3%,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of Infanib were 76.7%,88.0%,79.3% and 86.3%,respectively.The sensitivity,specificity,positive predictive value and negative value of aEEG and Infanib were 76.7%,88.0%,79.3% and 86.3%,respectively.There was no significant difference in sex predictive value(χ~2=0.09,1.19,0.88 and 0.17,respectively,P>0.05).Conclusion The results of aEEG examination can detect brain injury in early stage,and abnormal aEEG indicates poor prognosis in children,which has great predictive value in the outcome of neurological development of neonatal purulent meningitis.