Application Of Amplitude Integrated Electroencephalogram(aEEG)and Susceptibility Weighted Imaging(SWI)in Premature Infant With Brain Injury

Part 1 Application of amplitude integrated electroencephalogram(aEEG)in Premature Infants with Brain InjuryObjective:To investigate the clinical application value of amplitude integrated electroencephalogram(aEEG)in the premature infant brain.Methods:A total of 77 preterm infants admitted to the First People's Hospital of Nantong in September 2016 to March 2018 were selected,including 49 cases(gestational age:28-37 weeks)with brain injury(BIPI)and 28 cases(fetal ages:28-37 weeks)without brain lesions.23 normal full-term infants were set up as the control group.Post partum infants in both groups received continuously monitoring of aEEG for 3 hours each day within 72 hours after birth.Since the forth day,those infants have been administered the monitoring of aEEG over 3 hours every 7 days to the modified gestational age(37weeks).The indexes of aEEG were observed,including continuity(Co),sleep-wake cycling(SWC),lower margin amplitude(LMA),upper margin amplitude(UMA),narrow bandwidth and Burdjalov and Naqeed score.aEEG in both groups were analyzed and compared,and the characteristics and differences were observed.Results:In those premature infants without brain injury,the continuity of aEEG increased from 34.1%in the 29-32 weeks group,67.3%in the 32-35 weeks group to 92.1%in the 35-37 weeks group;the background and SWC of aEEG increased from 32.8%in the 29-32 weeks group,65.3%in the 32-35 weeks group to 89.6%in the 35-37 weeks group.With the increase of gestational age,the UMA(35.82±5.03,32.63±3.83 and 30.41±4.32)decreased(F=2.59,P=0.01),the LMA(4.16±1.43,4.89±1.62 and 5.61±1.51)increased(F=11.42,P=0.004),the bandwidth of aEEG(26.39±4.38,25.63±5.32 and 23.41±5.23)gradually narrowed(F=2.64,P=0.01),and all the features of which were closely association with gestational age.The background,Co,SWC,LMA,UMA,narrow bandwidth of aEEG and CFM was significant difference between those infants with gestational age(37 weeks)and normal full-term infants(P<0.05).The UMA,narrow bandwidth and CFM of aEEG in normal course were higher than those in BIPI group,while the LMA of aEEG was lower than a BIPI group(P<0.05).Burdjalov score and Naqeed criterion were used to determine the aEEG of 77 premature infants,37 cases were normal and 40 cases were abnormal.A total of 37 cases were abnormal in Burdjalov score.A total of 36 cases were abnormal in Naqeed criterion,11 cases were severe and 25 cases were mild.The UMA,LMA,narrow bandwidth and CFM of severe cases respectively were 35.45±3.12,3.04±0.52,27.58 ± 1.23and 4.15±0.83.Conclusion:With the increase of gestational age,the characteristics of aEEG in premature infants gradually approximate to normal full-term infants.The characteristics of aEEG in premature infants with gestational age(39 weeks)were same to normal full-term infants.aEEG is a good indicator to assess the maturity of brain development in premature infants.It could be used to timely detect preterm infants who have brain damage,including specific indicators and overall indicators.aEEG has important clinical application values in the preterm infants with brain injury because it has close relationship with brain damage.Part 2 Application of susceptibility weighted imaging(SWI)in Premature Infants with intracranial hemorrhageObjective:To observe the difference between magnetic susceptibility weighted imaging(SWI)and conventional magnetic resonance imaging(MRI)in premature infants,and to investigate the diagnostic value of MRI in brain development of normal premature infants and diagnostic advantage of SWI in intracranial hemorrhage of premature infants.Methods:A total of 77 preterm infants admitted to the First People's Hospital of Nantong in September 2016 to March 2018 were selected,including 49 cases(gestational age:28-37 weeks)with BIPI and 28 cases(fetal ages:28-37 weeks)without brain lesions.Ten normal full-term infants were set up as the control group.Post partum infants in both groups received conventional MRI and SWI at the modified gestational age(37 weeks)by Siemens Avanto 1.5T MR scanning system.The difference between myelination degree(M),cortical curl degree(C),residual germ matrix(GM),glial cell migration zone(B)and total TSM scores between normal preterm infants and full-term infants,The difference between SWI and conventional MRI were observed,including the number of bleeding cases,the number and location of microbleeding lesions.The differences of amplitude integrated electroencephalogram(aEEG)were analyzed in premature infants with different hemorrhage sites.Results:In 28 normal preterm infants with gestational age(37 weeks),the brain MRI showed homogeneous and moderate signal on MRI images.The grey and white matter was clearly demarcated.The ventricular system showed low and moderate signal,and no abnormal low signal was observed.There were no difference between conventional MRI and SWI.Venules on the surface of the brain and in the parenchyma of the brain were clearly showed in MinIP maps.In myelination degree(M),cortical curl degree(C),residual germ matrix(GM),glial cell migration zone(B)and total TSM scores,there were significant differences between normal preterm infants(29-32 weeks and 32-35 weeks)and full-term infants(P<0.05),there were no differences between normal preterm infants(35-37 weeks)and full-term infants(P>0.05).In 49 cases of BIBP,35,23 and 28 cases of ICH were detected by conventional MRI,DWI and SWI.The detection rates were 71.43%,46.94%and 57.14%.There was no significant difference between conventional MRI and DWI sequences(P>0.05).There were significant difference between conventional MRI,DWI and SWI(P<0.05),and SWI was higher than conventional MR and DWI.The detection rate of microbleeding lesions was 38.77%,24.48%and 16.32%in SWI,conventional MR and DWI respectively,with significant differences between SWI and conventional MRI(P<0.05).The number of microbleeding lesions was 32,20 and 17 respectively,and the difference was significant.The location of microbleeding lesions in premature infants by SWI was mainly in germinal matrix,subventricular ependymal,cerebral parenchyma and basal ganglia.The detection rates of microbleeding lesions in cerebellum were 37.50%(12/32),28.13%(9/32),31.25%(10/32),6.25%(2/32)and 0.00%(0/32).Routine MRI,DWI and SWI showed 85,70 and 106 respectively.There were more microbleeding lesions in SWI than conventional MRI and DWI.The rate of intracranial hemorrhage(ICH)was 50.0%(53/106),39.62%(42/106)and 10.38%(11/106).The most sites of ICH were germinal matrix,cerebral parenchyma and subependymal.There was no significant difference in the detection rate of ICH sites by MRI,DWI and SWI(P>0.05).There were 9,7 and 6 cases premature infants with intracranial hemorrhage respectively in germinal matrix-ventricle,brain parenchyma and extracranial area.There was no significant difference in the amplitude and electroencephalogram(aEEG)of premature infants with different hemorrhage sites(P>0.05).Conclusions:There was no significant difference between SWI and conventional MR in preterm at term-equivalent age,but SWI,especially MinIP images,could improve visualization of intracerebral venules which could not be display by conventional MR.There were significant difference brain maturity between difference premature infants on MRI,the degree of myelination(M)and glial cell migration zone(B)were more slowly than cerebral cortex curl(C)and germ matrix remnants(GM),which suggested the relation between brain maturity and the gestational age.The diagnostic rate and location of ICH in premature infants,the number and location of micro-hemorrhage lesions detected by SWI have significant advantages over conventional MRI sequence.The locations of ICH were mainly germinal matrix,cerebral parenchyma and subependymal space.SWI has diagnostic value for BIPI and is a powerful complement to conventional MRI sequence.There was no significant difference between the difference sites of hemorrhage and damage in brain.Part 3 Predictive value of amplitude integrated electroencephalogram(aEEG)combined with susceptibility weighted imaging(SWI)in the prognosis of brain damage in premature infantsObjective:The relationship between amplitude integrated electroencephalogram(aEEG)combined with magnetic sensitivity weighted imaging(SWI)and brain damage in premature infants(BIPI)was analyzed,and the predictive value in prognosis of premature infants was explored.Methods:A total of 77 preterm infants admitted to the First People's Hospital of Nantong in September 2016 to March 2018 were selected,including 49 cases(gestational age:28-37 weeks)with brain injury(BIPI)and 28 cases(fetal ages:28-37 weeks)without brain lesions.In 72 hours after birth,aEEG was recorded,MRI and SWI were performed at gestational age(37 weeks),neonatal behavioral neurological score(NBNA)was performed at gestational age(40 weeks),and MRI and Gesell scale was reviewed at gestational age(3 months).By ROC analysis,the predictive value was analyzed between the results of aEEG combined with MRI and its relationship with the prognosis of brain injury(BIBP)in preterm infants was investigated.Results:In the monitoring of NBNA at gestational age(40 weeks),there were significant differences between two groups.There were significant differences between two groups in the results of DQ at gestational age(3 months).There were significant differences between two groups in fine exercise,adaptability,language and social behavior(P<0.05),but with no difference in the results of big exercise(P>0.05).In those 35premature infants with intracranial hemorrhage examined by SWI at gestational age(3 months),there were 23 cases with lesion disappeared and 12 cases decreased.Using DQ in gestational age(3 months)as standards,the predicting value of aEEG in premature infant injury at 72 hours after birth was compared.The results showed that there were significant differences in upper boundary voltage,lower boundary voltage,narrow bandwidth and CFM score between normal and abnormal groups(P<0.05).The sensitivity of aEEG,SWI,aEEG combined with SWI in predicting brain injury in premature infants were 72.3%,48.9.0%and 85.7%,with specificity of 80%,60%and 90%,and the area under ROC curve(AUC)of 0.762,0.545 and 0.876 respectively.The sensitivity of aEEG was higher than that of SWI(P<0.05).However,the specificity of SWI was the lowest(P<0.05).aEEG compared with SWI had the highest sensitivity and specificity in the diagnosis of brain injury in premature infants,with the largest AUC(P<0.05).aEEG combined with SWI could be used as an effective means for early predictor of the prognosis of brain injury in premature infants.Conclusion:There was no significant difference in macromotor development of premature infants with gestational age(3 months),but the development of fine motor,language and social behavior lagged of them behind that of normal premature infants.There was no predictive value of single SWI in premature infants with brain injury.The results of early aEEG combined with SWI sequence can be used as an ultra-early predictor of the prognosis of brain damage in premature infants.