| BackgroundPrematurity is the leading cause of neonatal death all over the world,although the continuous development of related diagnosis and treatment techniques and auxiliary examination methods,survival of premature babies still face the problem of each system dysplasia,especially the problems of brain function development,ranging from mild nerve injury to severe intellectual disability,epilepsy or death.More and more studies have found that amplitude-integrated electroencephalogram(aEEG),which evaluates brain function by monitoring electrical activity in the cerebral cortex,provides valuable information about neurological diseases.The indicators of aEEG evolve with the progression of gestational age and age of day,which is of great value in the assessment,diagnosis and treatment of post-natal brain injury in premature infants.Many studies have evaluated aEEG from different aspects to evaluate the brain function of preterm infants of different gestational ages,while there is controversy about caffeine improving the brain function development of preterm infants.In this study,we will continue to study the changes aEEG indicators with gestational age and age of day,combined with MR results of preterm infants with 42 weeks’ PMA,to evaluate the predictive value of early aEEG indicators on brain structure damage of premature infants,and to explore whether caffeine use can improve EEG function of premature infants.ObjectivesTo explore the clinical significance of aEEG monitoring in evaluating EEG function of premature infants.MethodsA total of 189 neonates were born in our hospital from January 1,2019 to February 15,2021,and transferred to the Neonatal intensive care unit(NICU)within one hour after birth,among 169 preterm infants with GA < 37 weeks,those with genetic metabolic diseases,congenital malformation,chromosomal abnormalities,PMA-death within 42 weeks or incomplete data were excluded.Premature infants were divided into three groups according to different gestational age:16 patients in group A(GA 26～29+6 weeks),64 patients in group B(GA30～33+6 weeks),and 89 patients in group C(GA34～36 +6 weeks)were monitored three times(6-10h/ time)or above.The first monitoring was performed within 3 days after birth,and the second monitoring was performed on 7 days of age.The third monitoring was carried out at12 days of age.aEEG monitoring was started 2 hours before the dose of caffeine on the first day for 6-10 h in the preterm infants treated with caffeine.In the same period,the full-term infants who were admitted to hospital for three days without any complications due to high-risk factors during pregnancy were divided into group D,with 20 cases,and aEEG was monitored once within three days after birth,using aEEG’s background activities,voltage continuity(Co),sleep-wake cycle(SWC),interburst interval,(IBI),amplitude of the lower border(LB),Bandwidth(B)and Burdjalov evaluation system were used to evaluate the EEG function of premature infants.All enrolled preterm infants completed cranial MR examination at PMA 42 weeks.The chi-square test and Fisher’s exact probability method were used to analyze the changing rules of aEEG parameters of premature infants of different gestational ages.The Spearman correlation analysis was used to analyze the correlation between gestational age and aEEG score,as well as between gestational age and IBI.The Mann-Whitney U rank sum test was used to analyze the changing rules of aEEG parameters of premature infants of different age groups.The Mann-Whitney U rank sum test was used to analyze the difference in aEEG parameters within three days after birth in the normal and abnormal cranial MR groups,and the predictive value of aEEG parameters at different days of age for cranial MR abnormalities.The ROC curve was used to analyze the predictive ability of aEEG scores at different days of age for cranial MR abnormalities.The paired t-test and Wilcoxon signed rank sum test were used to analyze the Changes in brain electrical activity two hours before and after caffeine administration.Results(1)General information of premature infants: There were 189 subjects,including 169 premature infants in A,B and C groups,including 49 cases of vaginal delivery,120 cases of cesarean section,average GA(32.9±2.5)weeks,average birth weight(1883±502)g,108 cases of auxiliary ventilation,and first aEEG age of 2(1.5,2.8)days.There were 30 cases in normal brain MR group and 139 cases in abnormal brain MR group.There was no significant difference in gestational age,birth weight,sex,delivery mode and auxiliary ventilation between the two groups(P > 0.05).Incidence of birth asphyxia,maternal pregnancy hypertension,abnormal placental membranes and umbilical cord were significantly different between the two groups(P< 0.05).Among them,19 preterm infants were treated with caffeine,and 2 cases were excluded with data defects,a total of 17 cases were included.During the same period,20 cases in group D were all full-term infants whose mothers had high risk factors during pregnancy and were hospitalized for three days without any complications.Nineteen cases were born naturally,one case was born after cesarean section,with an average GA of(38.7±2.4)weeks,an average birth weight of(2906±308)g,0 case using auxiliary ventilation,and the age of first aEEG was 1.5(1.1,2.2)days.(2)The changing rules of aEEG of premature infants of different gestational ages: With the increase of GA,(1)Continuity increased significantly;(2)The proportion of SWC positivity in group B was higher than that in group A(54.69%vs.25.00%),and the difference was not statistically significant(P=0.050).The proportion of SWC positivity in group C was higher than that in group B(91.01% vs.54.69%),and the difference was statistically significant(P=0.000).The proportion of SWC positivity in group D was higher than that in group C(95.00% vs.91.01%),and the difference was not statistically significant(P = 0.358);(3)The amplitude of lower boundary gradually increased.The results of amplitude < 3μV showed that the proportion decreased significantly with the increase of GA,and the difference among premature infants was statistically significant(P=0.001,P = 0.029).The amplitude of3 ～ 5μV showed thatthe proportion of group A was lower than that of group B(56.25% vs.68.75%),there was no significant difference between group A and group B(P=0.384,),the proportion of group C was lower than that of group B(44.94%vs.68.75%),and the difference was statistically significant(p = 0.005).the proportion of group D was higher than that of group C(5.00% vs.44.94%)The results of amplitude > 5μV showed that the proportion increased significantly with the increase of GA,and the difference between the groups was statistically significant(P=0.032,P=0.000,p = 0.001);(4)Bandwidth gradually narrowed.Bandwidth > 20μV showed that with the increase of GA,the proportion was significantly reduced.The difference among groups of premature infants was statistically significant(P=0.002,P=0.000),and the proportion in group D was lower than that in group C(0.00% vs.11.23%).The comparison between groups showed no statistically significant difference(P =0.252).15μV < bandwidth < 20 μV showed that there was no statistically significant difference between groups in preterm infants(P=0.056,P=0.819),and the proportion in group D was lower than that in group C(10.00% vs.39.33%),with a statistically significant difference(P = 0.012).;The bandwidth < 15 μV showed that the proportion in group D was higher than that in group C(90.00% vs.49.44%),and the difference between groups was statistically significant(P = 0.001).The proportion in group C was higher than that in group B(49.44% vs.17.19%),and the difference was statistically significant(P = 0.000).The difference between group A and group B was not statistically significant(P = 0.109);(5)there is a moderate positive correlation between GA and Burdjalov total score(r=0.687,p = 0.000);GA was negatively correlated with IBI(r=-0.531,P=0.000).(3)The changing rules of aEEG of premature infants with different day-old were as follows: The total Burdjalov scores within three days of day-old were lower than those at seven days after birth[7.5(4.5,10.0)vs.8(5.0,10.3)],and the difference was statistically significant(P=0.015).The total Burdjalov scores within seven days after birth were lower than those on 12 days after birth [8(5.0,10.3)vs.9(6.0,11.0)],and the difference was statistically significant(P = 0.032).(4)The predictive value of aEEG for abnormal MR of the brain: the continuity score,periodicity score,lower boundary amplitude score,bandwidth score and total score of aEEG in premature infants with abnormal MR were lower than those in normal MR group within 3 days after birth,and the difference was statistically significant(P < 0.05).The Burdjalov total score in the abnormal MR group was lower than that in the normal MR group within 3 days,7 days and 12 days after birth,and the difference was statistically significant(P<0.05).The Burdjalov total score within 3days,7 days and 12 days had certain predictive value for PMA 42 days MR abnormality,and the Burdjalov total score within 3 days had the highest predictive value for MR abnormality.(5)The effect of caffeine on cerebral cortex electrical activity of premature infants during use: the IBI 2 hours after using caffeine was shorter than that 2 hours before using caffeine [(10.38 2.93)s vs.(12.74 3.48)s],and the difference was statistically significant(P=0.000).The Burdjalov score of 2 hours after caffeine use was higher than that of 2 hours before caffeine use [8(4.5,9.5)vs.8(3.5,9)],and the difference was statistically significant(P=0.027).Conclusion1.The aEEG pattern changes with the development of brain function after birth.With the increase of GA,the voltage continuity increases,the sleep-wake cycle becomes more and more obvious,the lower boundary amplitude increases,and the bandwidth narrows,aEEG can be used as an important tool to evaluate the maturity of brain electrical function in premature infants.2.With the increase of age,the brain electrical function of premature infants matured continuously,and the aEEG scores of premature infants increased significantly within 3 days,7 days and 12 days after birth.3.The low total score of Burdjalov and the scores of aEEG continuity,periodicity,lower boundary amplitude and bandwidth in 3 days after birth indicate that brain injury may occur.The predictive value of aEEG monitoring in 3 days after birth for PMA 42 weeks is higher than that in 7 days and 12 days after birth.aEEG can be used as an important tool for early prediction of brain structure damage in premature infants.4.Caffeine increased the electrical activity of cerebral cortex in premature infants. |
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