The Value Of AEEG In Predicting The Prognosis Of Nerve Injury In Very Low Birth Weight Infants With Different Effects Of Caffeine

Objective:Apnea of prematurity(AOP)is a common respiratory disease in premature infants.The younger the gestational age or birth weight,the higher the incidence.Frequent or recurrent episodes of AOP increase the risk of adverse neurological outcomes in preterm infants and thus require clinically active intervention.Caffeine is one of the important approaches to prevent AOP,but there are still some premature infants with poor efficacy.Therefore,this study further explored the value of amplitude integrated electroencephalography(aEEG)in diagnosing neurological damage in very low birth weight infants(VLBWI)who were effective or ineffective after caffeine prophylactic application.The role of aEEG in the early diagnosis and prediction of brain injury is expected to provide a theoretical basis for the prediction of the prognosis of VLBWI nerve injury that is ineffective after the preventive application of caffeine.Methods:VLBWI with a birth weight of 1.0-1.5 kg who were transferred to the NICU immediately after delivery in the obstetrics department of Jiujiang Maternal and Child Health Hospital from October 2021 to January 2023 were selected for the study,and78 cases were finally included in the study after excluding one case of metabolic bone disease and two cases of children who gave up treatment.After prophylactic treatment with caffeine citrate,children with apnea episodes were included in the observation group(n=39)and those without apnea were included in the control group(n=39),and general information was collected.The children completed aEEG examination 5 days after the drug administration to determine whether there was any group difference in general information and aEEG score results between the two groups.The cranial MRI and NBNA scores were perfected after follow-up until 40weeks of corrected gestational age,and the cranial MRI brain injury results were used as the gold standard to determine the early diagnosis and predictive value of aEEG.The results of the NBNA score were collected,and the correlation between aEEG score and the NBNA score was analyzed.The data were statistically analyzed by applying spss26.0,and the measurement data were expressed as mean±standard deviation((?)±s).t-test was used to compare the means between groups,and the correlation between aEEG score and NBNA score was analyzed by the Pearson correlation coefficient.Results:1.78 cases of VLBWI after 5 days of treatment,39 cases did not have AOP and39 cases still had recurrent AOP;the differences were not statistically significant(P>0.05)compared with gender,gestational age,birth weight,and 1min neonatal Apgar score in the two groups.2.aEEG periodicity,lower bandwidth amplitude,total Burdjalov score,and corrected gestational age 40 weeks NBNA score were lower in the observation group than in the control group,and the difference was statistically significant(P<0.05).3.Only 3 cases in the control group showed brain injury by MRI examination,brain injury prevalence was 7.69%.In the observation group,21 cases were normal by MRI and 18 cases had brain injury,and the brain injury prevalence was 46.15%The cranial MRI results of the two groups of children were subjected to x~2 test,and there was a significant difference in cranial MRI nerve damage between the two groups(x~2=14.662,P<0.001).4.20 cases were normal by aEEG and 19 cases had maturation disorders in the observation group;the sensitivity of aEEG in predicting VLBWI neurological injury with AOP was 88.88%(16/18),the specificity was 85.71%(18/21)and the accuracy was 87.18%(34/39).The kappa test showed fair diagnostic agreement between aEEG and MRI(kappa=0.743,P<0.001).The sensitivity of aEEG to predict VLBWI nerve injury without AOP was 100%(3/3)the specificity was 94.44%(34/36),and the accuracy was 94.87%(37/39);the concordance between aEEG examination and cranial MRI for nerve injury diagnosis in the control group was fair(kappa=0.723,P<0.001).The sensitivity of aEEG in predicting neurological injury by VLBWI in both groups was 90.48%(19/21),the specificity was 91.23%(52/57)),and the accuracy was 91.03%(71/78);kappa concordance test showed that for VLBWI aEEG examination was in better agreement with cranial MRI for the diagnosis of neurological injury(kappa=0.782,P<0.001).5.The scatter plot of aEEG Burdjalovp score and NBNA score plotted after 40 weeks of corrected gestational age was essentially linear for both groups of children,and Pearson correlation coefficient analysis showed that NBNA scores in the control group were positively correlated with aEEG scores in the control group(r=0.430,P<0.05);NBNA scores in the observation group were positively correlated with aEEG scores in the observation group(r=0.527,P<0.05)。Conclusions:1.The incidence of neurological injury was higher in very low birth weight infants who developed AOP despite prophylactic caffeine administration and may affect their neurodevelopmental maturation process and later neurobehavioral development.2.aEEG has a predictive value for nerve damage in VLBWI with AOP,which can detect nerve damage early and provide guidance for the development of early targeted clinical treatment.