aEEG对患呼吸暂停极低出生体重儿神经损伤的预测价值

Predictive value of aEEG for nerve injury in very low birth weight infants with apnea

目的探讨振幅整合脑电图(amplitude integrated electroencephalogram,aEEG)预测不同咖啡因疗效极低出生体重儿(very low birth weight infant,VLBWI)神经损伤预后的价值。方法选取2020年1月2022年1月于九江市妇幼保健院分娩的78例VLBWI作为研究对象。依据经5d治疗后是否出现早产儿呼吸暂停(apnea of prematurity,AOP)分组,将40例未出现AOP纳入对照组,将38例仍反复出现AOP纳入观察组。比较aEEG评分、纠正胎龄40周时新生儿神经行为测定(neonatal behavioral neuroiogical assessment,NBNA)评分;并于纠正胎龄40周时完善磁共振成像(magnetic resonance imaging,MRI)检查,评估aEEG在预测伴有AOP的VLBWI神经损伤中的价值,分析aEEG评分与NBNA评分的相关性。结果78例VLBWI经5d治疗后,40例未出现AOP,38例仍反复出现AOP;两组性别、胎龄、出生体质量、1min新生儿Apgar评分相比,差异均无统计学意义(P>0.05);观察组aEEG评分、纠正胎龄40周NBNA评分低于对照组,差异有统计学意义(P<0.05);经MRI检查22例正常,16例脑损伤;经aEEG检查20例正常,18例提示脑发育成熟障碍;aEEG预测伴有AOP的VLBWI神经损伤的敏感度为87.5%(14/16),特异性为87.5%(18/22),准确度为84.2%(32/38);kappa检验显示,aEEG与MRI诊断一致性尚可(kappa值=0.682,P<0.001);经Spearman相关分析显示,NBNA评分与aEEG评分呈正相关(r=0.582,P<0.05)。结论aEEG在VLBWI神经损伤预后预测中具有较高价值,能够及早发现神经损伤,为临床早期针对性治疗的开展提供指导。

Objective To explore the value of amplitude integrated electroencephalogram(aEEG)in predicting the prognosis of nerve injury in very low birth weight infants(VLBWI)with different caffeine effects.Methods A total of 78 cases of VLBWI delivered in Jiujiang Maternal and Child Health Hospital from January 2020 to January 2022 were selected as the study subjects.According to the grouping of premature apnea(AOP)after 5 days of treatment,40 cases without AOP were included in the control group,and 38 cases with AOP were included in the observation group.Compare the aEEG score and the neonatal neurobehavioral test(NBNA)score at the corrected gestational age of 40 weeks;At 40 weeks of corrected gestational age,magnetic resonance imaging(MRI)was improved to evaluate the value of aEEG in predicting VLBWI nerve injury with AOP,and to analyze the correlation between aEEG score and NBNA score.Results After 5 days of treatment in 78 VLBWI patients,40 patients did not have AOP,38 patients still had AOP repeatedly.There was no significant difference between the two groups in sex,gestational age,birth weight,and Apgar score of 1 minute newborn(P>0.05).The aEEG score and corrected gestational age 40 week NBNA score in the observation group were lower than those in the control group,with statistically significant difference(P<0.05);22 cases were normal and 16 cases were brain injury;Through aEEG examination,20 cases were normal,and 18 cases showed brain maturation disorder.AEEG predicted VLBWI nerve injury with AOP with sensitivity of 87.5%(14/16),specificity of 87.5%(18/22)and accuracy of 84.2%(32/38);Kappa test showed that the consistency between aEEG and MRI diagnosis was acceptable(kappa value=0.682,P<0.001);Spearman correlation analysis showed that NBNA score was positively correlated with aEEG score(r=0.582,P<0.05).Conclusion aEEG has a high value in predicting the prognosis of VLBWI nerve injury,which can detect nerve injury as early as possible and provide guidance for the development of clinical early targeted treatment.