The Predictive Value Of Modified AEEG Score Combined With Blood PH,Base Excess,NSE And CysC For Early Diagnosis Of Neonatal HIE And Recent Neurobehavioral Abnormalities

Objective: The early diagnosis and recent neurobehavioral abnormalities of neonatal HIE were evaluated by modified amplitude-integrated electroencephalography(a EEG)score,p H,base excess,neuron specific enolase(NSE)and cystatin C(Cys C),so as to provide effective reference value for the early diagnosis and treatment of HIE children and improve the prognosis.Methods:(1)From August 2020 to January 2023,73 neonates with HIE who were born in the obstetrics department of the Affiliated Hospital of Youjiang Medical College for Nationalities and hospitalized in the neonatal department after birth were selected as the study group.All children were full-term infants.HIE was clinically diagnosed,and neurological infections,electrolyte disorders,intracranial hemorrhage,severe genetic diseases,brain development malformations,sepsis,hypoglycemia,premature birth and other diseases that cause brain damage were excluded.According to the diagnostic criteria of neonatal hypoxic ischemic encephalopathy,the study group was divided into mild HIE group,moderate HIE group and severe HIE group,and 30 normal newborns born in our hospital during the same period were selected as the control group.(2)The basic clinical data,gestational age,gender,head circumference,body length and weight of the two groups were compared.(3)All subjects were examined for p H,base excess,NSE and cystatin C,and a EEG monitoring and modified a EEG score were performed within 24 hours after birth.(4)The differences of modified a EEG score,p H,base excess,NSE and cystatin C between the study group and the control group were compared.(5)The early diagnostic value of modified a EEG score,p H,base excess,NSE and cystatin C for neonatal HIE was analyzed by the test worker curve.(6)The study group was divided into normal NBNA score group and low NBNA score group according to NBNA score at 1 month after birth.The differences of modified a EEG score,p H,base excess,NSE and cystatin C between the two groups were compared.(7)Multivariate regression analysis of recent neurobehavioral abnormalities in children with HIE.(8)The predictive value of modified a EEG score and p H for recent neurobehavioral abnormalities in neonates with HIE was analyzed by the test worker curve.Results:(1)A total of 73 subjects were included in the study group,including 34 cases in the mild HIE group,21 cases in the moderate HIE group,18 cases in the severe HIE group,and 30 normal newborns in the control group.(2)There was no significant difference in gestational age,delivery mode,gender,body length,head circumference,birth weight and parity between mild HIE group,moderate HIE group,severe HIE group and control group(P > 0.05).(3)There were significant differences in modified a EEG score,p H,base excess and NSE among the four groups(F = 57.19,83.35,37.02,64.78,P < 0.05).There was no significant difference in cystatin C among the four groups(F = 2.05,P = 0.11).Compared with the moderate HIE group,the modified a EEG score,p H and base excess in the severe HIE group were lower(P < 0.05),and the NSE level was higher(P < 0.05).Compared with the mild HIE group,the modified a EEG score,p H and base excess in the moderate HIE group were lower(P < 0.05),and the NSE level was higher(P < 0.05).Compared with the control group,the modified a EEG score,p H and base excess in the mild HIE group were lower(P <0.05),and the NSE level was higher(P < 0.05).(4)The ROC curves of modified a EEG score,p H,base excess,NSE and their combination in the diagnosis of HIE were drawn.The AUC was 0.913,0.912,0.915,0.99 and 1.000,respectively.The best predictive values of modified a EEG score,p H,base excess and NSE for neonatal HIE were 10.500 points,7.335,-7.950 mmol / L and 25.68 ug / L,respectively.(5)There was no significant difference in body length,head circumference,birth weight and gravidity between the normal NBNA score group and the low NBNA score group(P > 0.05).The modified a EEG score and p H of the two groups were compared.The lower the modified a EEG score and p H,the higher the risk of neurobehavioral dysplasia in children.The boundary value of the modified a EEG score for the diagnosis of recent neurobehavioral abnormalities in children with HIE was 8.5 points.The cut-off value of p H in the diagnosis of recent neurobehavioral abnormalities in HIE children was 7.185.Conclusion:(1)Modified a EEG score,blood p H,base excess and NSE were related to the severity of HIE.The lower the blood p H,base excess and modified a EEG score,the more severe the disease.The higher the serum NSE level,the more severe the disease.(2)Serum cystatin C has no value in the diagnosis of neonatal HIE.(3)Modified a EEG score,blood p H,base excess and NSE have predictive value for HIE,and the combined diagnosis of the four has the highest diagnostic efficiency and more reference value.(4)Modified a EEG score and blood p H are associated with neurobehavioral abnormalities in neonates with HIE,and have certain predictive value.