The Clinical Application Of Sleep-wake Cycle In Full-term Neonates With Asphyxia And The Analysis Of Prognostic Value

Objective:Brain damage after asphyxia and ischemia may lead to different types and degrees of outcome.The purpose of this study was to study the performance of sleep-wake cycle(SWC)of amplitude integrated electroencephalogram(aEEG)in full-term neonates with asphyxia,and to evaluate the value in determining the degree of brain damage after asphyxia and to predict neurobehavioral development results.Methods:From January 2016 to June 2019,107 cases of full-term neonates with asphyxia who were hospitalized in the neonatal ward of the Children’s Hospital of Soochow University underwent 24-hour brain function monitoring within 7 days after birth.The Apgar score was<7 points in 1 minute,gestational age≥37 weeks and<42 weeks,and other diseases that may cause brain damage such as intractable hypoglycemia and genetic metabolic diseases were excluded.All 107 cases were resuscitated by asphyxiation in obstetrics department,and received electrocardiogram monitoring after admission to our hospital,and were given corresponding support and symptomatic treatment.According to their SWC,they are divided into normal SWC group(mature SWC)and abnormal SWC group(including immature SWC and no SWC).(1)Comparison of basic clinical data between the two groups of children;(2)Analyze the abnormal degree of SWC in different asphyxiation degree and examination time;(3)The correlation between the abnormality of SWC and cranial MRI and neural development was analyzed.(4)Receiver operating characteristic curve(ROC)was used to analyze and compare the prediction functions of SWC and cranial MRI on HIE.(5)The sensitivity,specificity,positive predictive value and negative predictive value of SWC abnormality in the prediction of HIE and abnormal developmental quotient were analyzed.(6)Logistic regression was used to verify the relationship between multiple factors and SWC.Results:(1)There were no statistically significant differences in gestational age,weight,gender and delivery mode between the two groups(P>0.05).(2)No matter the degree of asthenia,the abnormal detection rate of SWC was correlated with time,χ2=17.869,P=0.000,P<0.05.There was statistical significance between the abnormal detection rate of SWC and the aEEG examination time.The earlier the examination time was,the higher the abnormal detection rate of SWC was.(3)Asphyxiation degree and SWC abnormality were statistically significant(χ2=18.295;P<0.001,r=0.414,P<0.001).(4)Clinical score of abnormal SWC and HIE was statistically significant(χ2=15.234,P<0.001,r=0.669,P<0.001).(5)The difference between MRI and SWC was statistically significant(χ2=33.165,P<0.001,r=0.545,P<0.001).There were significant differences in SWC between severe MRI abnormalities and normal,mild MRI abnormalities and moderate MRI abnormalities.(6)The AUC under the ROC curve of SWC in early HIE pre-asphyxia children is 0.797,P<0.001,suggesting that abnormal SWC is of moderate accuracy in the prediction of HIE.(7)For 82 children with aEEG and head MRI,the ROC curve area of early prediction of HIE was 0.754,P<0.001.MRI:AUC was 0.876,P<0.001,and the prediction accuracy of head MRI was higher than that of SWC.(8)The sensitivity and specificity of the abnormal SWC to predict HIE were 67.6%and 91.7%,respectively.The positive predictive value was 79.3%and the negative predictive value was 85.9%.(9)The maturation degree of SWC and neurobehavioral development prognosis were statistically significant(χ2=20.967,P<0.001),the more abnormal development of SWC,the lower the prognosis was,the worse the prognosis was.(10)The sensitivity,specificity,positive predictive value and negative predictive value of SWC were 62.5%,87.5%,58.8%and 89.1%respectively to predict developmental quotient abnormality.(11)aEEG detection time,asphyxia degree,HIE score,head MRI result score and SWC abnormality are all related,and have statistical significance.Logistic regression verification showed that only HIE score was statistically significant.Conclusion:The presence or absence of SWC reflects the severity of neonatal exposure to hypoxic ischemic injury.The degree of abnormality of SWC is highly specific to predict HIE and abnormal neurobehavioral development,and the negative predictive value is high.