| Amplitude integrated electroencephalogram(aEEG) is a new technology, developed in recent years for clinical neonatal EEG monitoring. It is a simplified, single-channel EEG physiological monitoring, not only to reflect changes in background activity, but also reflect epileptiform activity. The advantages of the aEEG includes portablity, easy to apply, less interference by the environment, easily interpreted and continuous bedside monitoring. Therefore, brain function monitoring with aEEG has become routine care in many neonatal intensive care unit (NICU)In China, only few NICU begin brain function monitor with aEEG for clinical and experimental research. The extensive use of aEEG in China is difficult for the import equipment is expensive. The difficult of prevention and therapy for perinatal brain damage in China is higher incidence, more severity, unable to carry out early bedsite EEG, CT, MRI and so on. Therefore it is urgent to invent a monitor which is portable, unexpensive, easy to use in bedside and interpret the result, so that we can diagnosis and treat infants with perinatal brain damage early. Children's Hospital of Fudan university, together with Shanghai Jiaotong University, developed a domestic digital amplitude integrated cerebral function monitor. We monitored normal term and preterm infants as well as brain injury infants with the domestic "digital amplitude integrated cerebral function monitor", the similar import instrument and convention EEG simultaneously, to confirm the function of domestic digital amplitude integrated cerebral function monitor, and to study the characteristics of aEEG of normal full-term and preterm newborns, and changes of their maturation with gestational age and extrauterine environmental of preterm.Part one Verification of the domestic digital aEEG Objective:To verificate the function of domestic digital amplitude integrated EEG instrument. Methods:A total of 20 normal newborns and 8 neonatal brain injury newborns were monitored for 2 hours with domestic digital amplitude integrated cerebral function monitor (CFM3000) and similar imported products LECTROMED CFM 5022 simultaneously. The continuity, sleep-wake cycle, lower and upper bound voltage and time course of broad and narrow band, and width of the aEEG tracings were analysis.32 newborns with seizures or suspected seizures were monitored with CFM3000 and conventional EEG simultaneously. The sensitivity and specificity of CFM3000 in the diagnosis of of neonatal convulsions were analysis. Results:The tracings of aEEG monitored by CFM3000 and CFM 5022 are similar. The continuous electrical activity and sleep-wake cycle were detected in 19/20, no significant statistical difference between the mechines; the mean of lower,upper bound voltage and duriation of broad band minitoted by CFM3000 were 10.5±3.9μV,37.6±5.3μV and 23.5±10.4 min respectively, and CFM 5022 were 10.4±3.9μV,37.8±4.7μV and 23.5±10.4 min respectively, there was no significant difference; the mean of lower,upper voltage and duriation of narrow band minitoted by CFM3000 were 11.8±0.6μV,23.1±0.4μV and 46.8±17.2 min respectively, and CFM 5022 wrer 11.8±0.7μV,23.2±0.5μV and 46.8±17.2 min respectively, there was no significant difference; The infants with aEEG tracing of continuty low voltage, convulsions, burst-suppression and platform voltage were 3,2,1 and 2 amang 8 infants with brain injury monitored by CFM3000 respectively, the same as intants monitored with the CFM 5022, there was no significant difference.32 infants with or suspected clinical seizure were monitored by CFM3000 and conventional EEG. The detection rate of seizure with CFM3000 and conventional EEG were 53.1%and 68.8%respectively, there is no statistically significant difference, P= 0.125; The consistency with Kappa test was:Kappa=0.552, P=0.001. The aEEG's sensitivity and specificity to detect seizure is 72.7% and 90% respectively.Conclusions:The CFM3000 is reliable and stable.Part Two The characteristics of aEEG of Normal full-term newbornsObjective:To study the characteristics of aEEG of normal full-term neonates within 3 days after birth. Methods:aEEG was record for three hours by the first national of amplitude integrated EEG instrument at the age of 1,2and 3d in normal full-term newborns; Voltages of aEEG was calculated with semi-logarithmic formula by hand. The background, voltage and sleep-wake cycle were analysis. Results:①For normal full-term newborns, the background of aEEG was continuous voltage, and sleep-wake cycle was seen in 90.5% and 100%at the first day and at the second and third day after birth respectively.②The average duration of sleep-wake cycle was 69.1±19.5min. The average duration of sleep and awake phase was 22.1±5.6min, and 47.3±18.0min respectively.③The minimum amplitude of the aEEG background were 12.4±2.1μV,12.3±2.0 u V and 12.5±2.6μV at the age of 1,2 and 3 days old respectively; the maximum amplitude were 37.7±10.1μV,38.6±9.3μV and 38.6±8.9μV at the age 1,2 and 3 days old respectively.④The gestational age, age, gender, mode of delivery and maternal complications of pregnancy was no effect on aEEG voltage and sleep-wake cycle among 38-42 gestational ages in normal newborns. The voltages of the upper boundary of broad and narrow band was higher within the first three days at 37 week of gestational age than those at 38-42 week of gestational age, especially the voltages of narrow-band (P= 0.014). Conclusions:In normal full-term newborns, the aEEG background was continuous voltage and sleep-awake cycle was seen; the minimum voltage was> 5μV and the maximum voltage＞10μV. The gestational age, age, sex, mode of delivery and maternal complications of pregnancy had no effect on aEEG in normal full-term newborn infants except 37 weeks gestational age.Part three The characteristics of aEEG in preterm and changes of maturation with gestational age and extrauterine environmental lifeObjective:To study the characteristics of.aEEG in preterm and changes of maturation with gestational age and extrauterine environmental life.Methods:A total of 135 pretern infants with gestational age 28-36 weeks were invovled. The first aEEG monitoring was done within 3 days old and then once weekly until discharge (or maximum to PMA 37 weeks) with domestic digital aEEG (CFM3000). Duration of each recording was at least 4 hours. The continuty,sleep-wake cycle,voltage and bandwidth of all aEEG tracing were analysis. Results:①aEEG tracings evolved from the immature to mature with gestational age. The percent of continuty background increased from 30%(3/10) of 28 weeks to 85.7%(12/14) of 36 weeks; the percent of mature sleep-wake cycle increased from 10%(1/10) of 28 weeks to 100%(14/14) of 36 weeks. Low bound voltage increases with gestational age, from 6.8±1.7μV(28w) to 9.7-10.1μV(35-36w). Bandwidth of the narrow band decreases gradually with gestational age, from 1.45±0.32cm (28 w) to 0.86±0.24cm (36 w). aEEG total score increased from 8.3±0.8(28 w) to 13.5±0.9(36 w), P<0.0001. The evolution of aEEG in preterm has a significant correlation with gestational age. The correlation coefficient for continuty,sleep-wake cycle,low bound voltage and bandwidth of narrow band, and total score were 0.32,0.81,0.38,0.55 and 0.78 respectively, P＜0.05.②Extrauterine life of preterm accelerated aEEG maturity. The rate of continuous voltage and sleep-wake cycle were higher, lower bound voltage of narrow band was higher and band width was narrow in infants after correcting for PMA than the same gestational age; The maturity of aEEG was significantly correlated with PMA. The correlation coefficient for continuty,sleep-wake cycle,low bound voltage and bandwidth of narrow band, and total score were 0.35,0.81,0.37,0.56 and 0.78 respectively, P＜0.05. Further analysis of correlation between the score of continuty,sleep-wake cycle,voltage and bandwidth of aEEG and PMA shown:except for infants with GA 35 and 36 week, the mean score of continuty,sleep-wake cycle,voltage and bandwidth were increased with PMA, P<0.05; In infants with GA 35 week, the score of voltage and bandwidth of aEEG was correlation with PMA,while the score of continuty,sleep-wake cycle of aEEG was independed on PMA; The tracings of aEEG was become mature in infants with GA 36. The score of continuty,sleep-wake cycle,voltage and bandwidth of aEEG were all independed on PMA. Conclusions:①. The maturity of aEEG in preterm depends on gestational age.②After birth, maturity of preterm aEEG is also related to PMA, smaller gestational age preterm show a relatively acceleration of maturity of aEEG.SummaryOur research suggest:1. The domestic digital amplitude integrated EEG can response to the change of brain function, detect the brain damage in neonates, the detection rate of neonatal seizure close to the conventional EEG. The function of domestic digital amplitude integrated EEG was reliable and stable.2. In normal full-term newborns, the aEEG background was continuous voltage and sleep-awake cycle was seen; the minimum voltage was> 5uV and the maximum voltage> 10μV.3. The maturity of aEEG in preterm depends on gestational age. The greater of gestational age at birth, the more mature of aEEG tracings, presents with more continuity background of aEEG graphics, more clearer sleep wake cycle, increased low bound voltage, narrow bandwidth.4. After birth, maturity of preterm aEEG is also related to PMA, smaller gestational age preterm show a relatively acceleration of maturity of aEEG.
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