Application Value Of The Amplitude Integrated Electroencephalography In Early Diagnosis And Treatment Of Hypoxic-ischemic Encephalopathy And Long-term Prognosis

Objective: To explore the application value of the aEEG in early diagnosis andtreatment of HIE and long-term prognosis by researching on the changing characteristicof amplitude integrated Encephalopathy (aEEG) in the pathogenesis ofhypoxic-ischemic encephalopathy (HIE).Methods: A total of120cases of newborns with HIE who were hospitalized fromMarch2011to January2012were selected from neonatal intensive care unit (NICU)ofour hospital, and their gestational ages were from34weeks to42+2weeks.120cases ofnewborns were randomly dividing into the observation group with aEEG and non-observation group, each group having60cases. According to the severity of HIE, eachgroup was divided into mild,moderate,and severe subgroup, each subgroup having20cases.All the treatment was in accordance with the principle of Chinese MedicalAssociation,"three symptomatic，three support", and corresponding treatment wasadded into the observation group with aEEG.A total of60normal newborns born indepartment of obstetrics of our hospital were selected as control group. aEEG wasrespectively traced at time points(1,3,14and28day) after birth for observation groupwith aEEG and traced at time points(1and3day) after birth for control group. Theoutcome of aEEG was divided into normal, mildly abnormal and severely abnormalaEEG according to Background activity. The observation group with aEEG andnon-observation group took the Neonatal Behaviral Neurologieal Assessment (NBNA)assessment at time points(3,14and28day) after birth, and the preterm newborns tookthe assessment after corrected gestational age of full40weeks. Define40as the fullpoint for NBNA score, more than35as qualified and below35as unqualified.Doingfollow-up research for three groups after corrected gestational age of3months,6months and12months, the follow-up investigation including magnetic resonance imaging(MRI), Denver Developmental Screening Test (DDST) and nervous system sequelae.All data was analyzed by SPSS17.0, the results were expressed as mean±standarddeviation (x±SD), after the test of normality and variance test of homogeneity, we usethe F-test and we use Chi-square inspection to do the comparison of the frequency, wetake t test for the comparison data and Spearman rank analysis for correlation of the twogroups. P <0.05is shown as statistically significant.Result:1.The results of the observation group with aEEG at1day times point:6cases withmild HIE (100%) were normal aEEG.29cases were mildly abnormal aEEG,14(48.3%)cases of whom had mild HIE,10(34.5%)cases of whom had moderate HIE and5(17.2%) cases of whom had severe HIE.25cases were severely abnormal aEEG,10(40%)cases of whom had moderate HIE,15(60%)cases of whom had severe HIE.There was strong positive correlation between aEEG and HIE clinical indexing (r=0.843, P <0.01).2.The results of the observation group with aEEG at3day times point:8cases withmild MRI (100%) were normal aEEG.30cases were mildly abnormal aEEG,11(36.7%)cases of whom had mild MRI,19(63.3%)cases of whom had moderate MRI.22cases were severely abnormal aEEG,2(9.1%)cases of whom had moderate MRI,20(90.1%)cases of whom had severe MRI. There was strong positive correlationbetween aEEG and MRI(r=0.876, P <0.01).3. At3day and14day time points,it was not statistically significant for the NBNAscore between observation group with aEEG and non-observation group (P＞0.05)while it was statistically significant for the NBNA score between observation groupwith aEEG and non-observation group at28day time poin t(P＜0.05).4.At1，3，14and28day time points, The aEEG results for observation group witha EEG had strong positive correlation with prognosis after corrected gestational age of12month(r=0.832、0.857、0.778、0.743，P＜0.01). At1day time points, the severelyabnormal aEEG could forecast abnormal prognosis and the susceptibility is95.8%, thespecificity is94.4%,the positive predictive value is92%,the negative predictive value is97.1%.5. The disable rate in the observation group with aEEG (13.8%) was significantly lower than that in the non-observation group (23.2%); the cure rate (60%) in theobservation group with aEEG was significantly higher than that in the non-observationgroup (40%). The long-term prognosis of the observation group with aEEG and thenon-observation group was statistically significant (χ~2=4.107, P <0.05).Conclusion:1. The aEEG has excellent correlation with HIE clinical indexing, and can assist inearly diagnosis and treatment of HIE.2. The aEEG has excellent correlation with MRI and it can replace MRI to do earlydiagnosis and treatment of HIE.3. AEEG can be used to predict long-term prognosis of HIE, if the early results ofthe aEEG is poor, the long-term prognosis will be poor.