脑电图、事件相关电位及全身运动质量评估对高危儿神经发育的预测作用

Predictive values of electroencephalogram,event-related potential,and general movements quality assessment in neurodevelopmental outcomes of high-risk infants

目的探讨脑电图(EEG)、事件相关电位(ERP)及全身运动(GMs)质量评估对高危儿1岁时神经发育状态的预测作用。方法选择2016年1月至2018年6月在南通大学附属常州儿童医院住院的71例高危儿进行前瞻性研究,其中男38例,女33例;胎龄<37周23例,37~42周43例,>42周5例;病种为早产23例,窒息13例,新生儿缺氧缺血性脑病8例,低血糖5例,颅内出血9例,化脓性脑膜炎3例,胆红素脑病1例,新生儿重症肺炎7例,坏死性小肠结肠炎3例,支气管肺发育不良5例,部分高危儿同时有多个病种。高危儿均在矫正胎龄4周时进行EEG及ERP检测;同时在矫正4周及12周时进行2次GMs质量评估,矫正年龄1岁时采用Gesell发育量表对神经发育进行评估。以Gesell发育量表评估结果为1岁时神经发育结局,分别计算EEG法、GMs质量评估法、EEG+ERP法、EEG+ERP+GMs法预测高危新生儿神经发育结局的灵敏度、特异度、阳性预测值、阴性预测值。计数资料以例(%)表示,组间比较采用χ^(2)检验,采用Kappa系数一致性检验检测EEG法、GMs质量评估法、EEG+ERP法、EEG+ERP+GMs法与Gesell发育量表法检测结果的一致性。结果高危儿矫正年龄1岁时Gesell评估结果:脑瘫3例(4.23%),精神运动发育迟缓14例(19.72%),正常54例(76.05%)。EEG+ERP+GMs法灵敏度(90.00%)、特异度(95.08%)、阳性预测值(75.00%)及阴性预测值(98.31%)与1岁时Gesell评估结果及脑瘫临床诊断结果的Kappa系数一致性检验(Kappa=0.785),以上指标在4种方法中均最大。结论EEG、GMs质量评估、EEG联合ERP对高危新生儿不良神经发育结局都有较高的预测价值,EEG、ERP及GMs质量评估联合可大大提高预测高危新生儿不良神经发育结局的效果。

Objective To investigate the predictive values of electroencephalogram(EEG),event-related potential(ERP),and general movements(GMs)quality assessment in the neurodevelopmental status of high-risk infants at 1 year old.Methods Seventy-one high-risk infants hospitalized at Affiliated Changzhou Children's Hospital of Nantong University from January 2016 to June 2018 were included in this prospective study,including 38 males and 33 females.The gestational age was<37 weeks in 23 cases,37 to 42 weeks in 43 cases,and>42 weeks in 5 cases.There were 23 cases of premature delivery,13 cases of asphyxia,8 cases of neonatal hypoxic ischemic encephalopathy,5 cases of hypoglycemia,9 cases of intracranial hemorrhage,3 cases of purulentmeningitis,1 case of bilirubin encephalopathy,7 cases of neonatal severe pneumonia,3 cases of necrotizing enterocolitis,and 5 cases of bronchopulmonary dysplasia;some high-risk infants had multiple diseases at the same time.EEG and ERP were performed in the high-risk infants at 4 weeks of corrected gestational age,and GMs quality was evaluated twice 4 and 12 weeks after birth.The Gesell score was used to assess their neurodevelopment outcomes at 1 year old.With the Gesell scores as the neurodevelopmental outcomes at 1 year old,the sensitivities,specificities,and positive and negative predictive values of EEG,GMs quality assessment,EEG+ERP,and EEG+ERP+GMs were calculated to predict the high-risk neonatal neurodevelopmental outcome.The enumeration data were expressed as cases(%),and were compared between the groups byχ^(2) test.The Kappa coefficient consistency was used to test the consistencies of the Gesell scores with EEG,GMs quality assessment,EEG+ERP,and EEG+ERP+GMs.Results Of the 71 high-risk infants at the corrected age of 1 year diagnosed by the Gesell assessment and neurological tests,3 cases(4.23%)had cerebral palsy,14 cases(19.72%)had psychomotor retardation,and 54 cases(76.05%)were normal.The sensitivity,specificity,positive predictive value,and negative predictive value of EEG+ERP+GMs in the prediction of the neurodevelopmental outcomes in the high-risk infants were 90.00%,95.08%,75.00%,and 98.31%,respectively,which were the highest.The Kappa coefficient consistency for the reliability of predicting the neurodevelopmental outcomes of the high risk newborns by the EEG+ERP+GMs method was substantial at 0.785,while the other three methods got relatively low Kappa values.Conclusions EEG,GMs quality assessment,and EEG+ERP have high predictive values for adverse neurodevelopmental outcomes in high-risk newborns;the combination of EEG,ERP,and GMs quality assessment can greatly improve the prediction of neurodevelopmental outcomes of high-risk newborns.