| Background:At present the incidence of neonatal jaundice is still very high and it is the leading cause of neonatal hospitalization. Severe hyperbilirubinemia can lead to nerve cell damage and then bring series of neurological dysfunction. For example, it not only can be expressed as a series of clinical symptoms and changes in motor coordination disorders such as muscle tension, but also is one of the causes of cerebral palsy. And it can cause athetoid cerebral palsy, visual disorders, mental disorders and serious sequelae of nervous system. In order to reduce the incidence of bilirubin encephalopathy, it is advocate that early diagnosis and treatment at present stage shall be very important. After research for decades, method for early diagnosis of neonatal bilirubin encephalopathy consists of laboratory examination, neurophysiological and imaging examinations. Therapeutic methods include phototherapy, exchange transfusion, hyperbaric oxygen therapy and medication. Another animal studies has been shown to hypothermia treatment of acute bilirubin encephalopathy is validated. Currently, PET/CT( positron emission tomography X-ray computed tomography,PET/CT)is the most important molecular imaging equipment, it combine functional metabolism of PET with anatomy of CT, while reflect changes in anatomy and pathophysiology of the lesion, which can significantly improve the accuracy of diagnosis. In the diagnosis of the central nervous system diseases, it can also measure regional cerebral blood flow, oxygen partial metabolic rate, regional cerebral oxygen extraction fraction and local cerebral blood volume though PET imaging to measure brain energy metabolism by using intravenous injection of 18F-FDG(18F-fluorodeoxyglucose, 18F-FDG). It is few reported that PET / CT can be used in the field of neonatal, while theoretically, using 18F-FDG PET/ CT for early diagnosis of neonatal bilirubin encephalopathy is feasible. 18F-FDG PET/ CT has application value in judging the efficacy, assessing prognosis and worthy of further study. The a EEG(amplitude-integrated electroencephalogram, a EEG) has certain advantages as neurophysiological testing method. It has no limit about environment, objectivity, non-invasive and continuous checking means. Moet of all,it is suitable for NICU(Neonatal Intensive Care Unit, NICU). The a EEG is easy to operate, and has a few electrodes. In addition, the graphics are intuitive and easy to analyze, so that it is being carried out in clinical and abroad in progress, and favored by the majority of pediatricians.Objective: By researching and comparing, divide more than 36 weeks neonates into two groups. Conventional treatment group uses conventional treatment, the group in mild hypothermia therapy is on the basis of conventional treatment combined with hypothermia treatment. The first comparison is the changes of a plurality of a EEG project indicators and NSE before treatment and after treatment, as well as cerebral glucose metabolic rate after treatment. By researching, we want to provide the basis for a EEG early diagnosis, effectiveness of hypothermia treatment of neonate bilirubin encephalopathy and the applications of PET / CT in the field of neonatal.Methods: 29 newborns with bilirubin encephalopathy(all of them were hospitalized in the Affiliated Hospital of Sichuan Medical University from May. 2013 to Dec. 2014) are divided into two groups. The conventional treatment group(15 cases) use conventional treatment. While the group of another 14 cases use the conventional treatment together with the extra mild hypothermia treatment. Observation about the changes between these two groups in a EEG and NSE before treatment and after treatment, as well as the glucose metabolism rate on 18F-FDG PET/CT after treatment. Respectively measure the frontal lobe, temporal lobe, parietal lobe, occipital lobe, bilateral basal ganglia and thalamus average standard uptake values(SUV).Results:1 NSE results: NSE of both groups were significantly lower after treatment(P <0.05), the group with mild hypothermia method recover better than the conventional treatment group after treatment(P <0.05).2 The a EEG results: the SWC, epileptiform activity and the abnormal degree of conventional treatment group were significantly improvement after treatment, a plurality of a EEG project indicators of mild hypothermia therapy group were significantly improvement after treatment(P <0.05). Among them,the SWC, epileptiform activity and the abnormal degree of mild hypothermia therapy group recover better than the conventional treatment group after treatment(P <0.05).3 PET/CT results: There is a significant difference between two groups of cerebral glucose metabolic rate after treatment that each brain regions improved more significantly though mild hypothermia treatment than the other group.4 Correlation: the results of 18F-FDG PET/CT were correlated with the change of a EEG and NSE after treatment.Conclusions: a EEG can be used for the early diagnosis of bilirubin encephalopathy, and it has certain clinical value. Mild hypothermia treatment of neonatal bilirubin encephalopathy has certain curative effect, and it can better promote the neonatal bilirubin encephalopathy with brain cells to restore energy metabolism. The mild hypothermia treatment and 18F-FDG PET/CT examination had fewer side effects, can be safely used in clinical. |
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