Research On The Early EEG Monitoring Of Newborns With Servere Asphyxia And Predictive Value Of Prognosis

Perinatal asphyxia can result in moderate and severe hypoxic ischemic encephalopathy, which remains a main cause contributed to the death and the obstacles of neurobehavioral development of full-term neonates. In recent years, hypothermia therapy is recognized as the most likely treatment of neonatal brain protection.However,6 hours after birth is a critical time window for the implementation of hypothermia. Therefore, it is very important to predict hypoxic-ischemic earlier for neonates with asphyxia in order to select suitable neuroprotective interventions as soon as possible.Clinical routine monitoring and neuroimaging have a limited value in early prediction of brain damage. EEG can provide information of brain function and detect seizure discharge, which is a non-invasive, convenient means of brain function test. EEG is reliable in monitoring brain function and prognosing the outcome for asphyxiated newborns in the Neonatal Intensive Care Unit. Recently, bedside video-EEG can provide the timely, continuous and comprehensive monitoring of brain electrical activity.Studies showed that the EEG test applied 2～7 d after birth for full-term neonates with asphyxia had a better prognostic value in hypoxic ischemic encephalopathy and neurological development. But the predictive value of EEG applied 6～24 h after birth is still uncertain. So far, there are only limited studies in neonatal EEG mornitoring in 12 h after birth in the field of HIE, and few researches have focused on the evolution of EEG with hypoxic ischemic encephalopathy.As a means of assessing prognosis, EEG is often classified according to the degree of abnormal background activity, but lacking of quantitative criteria by now. The predictive value of mild and moderate abnormal EEG in HIE is still uncertain.The study design include:(1)to investigate the predictive value of bedside VEEG applied at 6 h after birth for neonates with hypoxic-ischemic encephalopathy and its severity, and the relevance of neurodevelopmental outcome; (2) to monitor VEEG in 6 h after birth for neonates with severe asphyxia, comparing correlation between VEEG and early neurodevelopmental outcome according to the available two abnormal EEG background standards.Part One The research on bedside video-EEG within 6 h after birth in predictive value of perinatal hypoxic-ischemic encephalopathy and its correlation with short-term neural and behavior developmentObjective To evaluate the diagnostic value of the bedside video electroencephalogram testing in neonatal within 6 h after birth with hypoxic-ischemic encephalopathy and the relationship of bedside VEEG result and early neuro-behavioral development.MethodBased on continually collecting neonatal severe asphyxia cases, recording and graduating the bedside VEEG, using HIE standard diagnostic program as clinic diagnostic and graduated gold standard.①To observe the sensitivity and the specificity of VEEG within 6 h after birth in predicting of prognosis of HIE. Observers were blind to clinical data. The sensitivity and specificity of VEEG, which was done 6 h, the third day and the seventh day after birth were compared.②All patients with abnormal VEEG were received neonatal behavior neurological assessment during 7-14d, EEG at 3 months and 6 months, general movements assessment and Developmental Screening Test for child under six at 3 months, and Bayley Scales of Infant Development at 6 months.Results1,48 neonates with severe asphyxia were include. Within 6 h after birth,9 patients with normal VEEG and 39(81.3%) patients with abnormal VEEG(16 mild,11 moderate,5 severe abnormal and 7 inactive VEEG). In 48 neonates with severe asphyxia,12 patients with severe asphyxia and 36 patients diagnosed as HIE(14 mild, 12 moderate,10 severe).2,We found within 6 h the VEEG is highly correlated with the degree of HIE(r= 0.849, P<0.001).The sensitivity and specificity of the VEEG within 6 h after birth were 100% and 94.7% respectively.The sensitivity of the VEEG mornitoring showed within 6 h,3d and 7d in neonates with HIE were 88.9%,83.9% and 28.6% respectively, and the specificity were 41.7%,91.7% and 100% respectively.3,Of 48 patients, there were 9 patients died in hospital.According to the different degree of VEEG from normal, mild abnormal, moderate abnormal to severe VEEG, the NBNA scores of 7-14 d old patients were 36.0±1.2,34.8±1.6,31.7±1.8 and 29.3±2.1 respectively. The NBNA scores of patients with moderate and severe abnormal EEG are significantly lower than those with normal EEG(both P<0.001);the NBNA scores of patients with severe abnormal EEG were significantly lower than those with moderate abnormal EEG (P=0.045), the NBNA score of 1 survival patient with inactive EEG was 25.35 patients were followed up when they were 3 month old, 32 patients DST>85 and 3 patients DST 70-84 with abnormal EEG. GMs assessment of one of the 3 patients showed absence of fidget movements, having high risk of cerebral palsy.14 patients were followed up when they were 6 months old,7 patients of them had abnormal EEG,4 patients had abnormal scores of Bayley scales of infant development accompanying with abnormal EEG.Part Two The predictive value of early EEG background in the prognosis of neurodevelopment with neonatal asphyxiaObjective To compare the predictive value of abnormal EEG background within 6 h after birth by different criteria in the prognosis of neurodevelopment of patients with neonatal asphyxia.MethodsAccording to the recent neonatal EEG criteria of Liu published in Clinical EEG 2008 (criteria A) and Murray's criteria (criteria B,published in Pediatrics 2006), we analyzed the VEEG including the EEG background and seizure discharges in the newborns with severe asphyxia. In order to follow up the neurodevelopment outcomes, we used NBNA during 7-14 d after birth, GMs and DST at 3 months of age, BSID at 6 months of age. VEEG were recorded at 6 h,3 d,7 d after birth. And we followed up the patient's EEG at 3 months and 6 months of age.Results1,48 severe asphyxia newborns were collected in this study (26 males and 22 females).The VEEG were normal in 9 cases and in 39 were abnormal, in which there were 11 cases with abnormal EEG background and 28 cases with abnormal EEG background and paradoxical discharges. 2,According to criteria A, there were 24 cases with mild abnormal EEG,8 moderate and 7 severe abnormal EEG. According to criteria B,there were 16 cases with mild abnormal EEG,11 moderate,5 severe abnormal EEG and 7 inactive EEG.3,By following up EEG,there were 27 of 43 cases with abnormal EEG at 3 d,8 of 40 cases with abnormal EEG at 7 d,10 of 35 cases with abnormal EEG at 3 months and 7 of 10 cases with abnormal EEG at 6 months. In 48 patients, there were 9 cases died, 20 of 39 cases with abnormal NBNA scores during 7-14 d,1 of 35 cases with abnormal GMs at 3 months,3 of 35 cases with abnormal DST scores at 3 months. There were 4 cases with abnormal BSID scores at 6 months and diagnosed as psychomotor retardation or cerebral palsy.4,We found no significant difference in the predictive value of mild and severe EEG background between criteria A and B.There were more cases with moderate abnormal EEG having poor neurodevelopment according to criteria A than that according to criteria B (5/8 cases vs 3/11 cases).Conclusions1,Monitoring VEEG at 6h after birth had a good sensitivity and specificity in prognosing HIE2,Monitoring VEEG at 6h after birth had a good relationship with short-term neural and behavior development.3,Both criteria A and B have the predictive value in the prognosis of neurodevelopment in the patients with neonatal asphyxia.4,There were some differences in the moderated abnormal EEG background determined by criteria A and B.5,Criteria A seemed to be more sensitive than criteria B in the evaluation of neonatal abnormal EEG background and the prediction of the neurodevelopment outcomes.