| Objective: With medical technology rapid development and a significant rising in premature infant survival rate, the survival infant’s gestational age had been reduced to less than 27 weeks. Still some preterm infants who had been hospitalized in NICU suffered extrauterine growth retardation(EUGR),the later lower height,lower immunity,nerve dysphasia, serious adverse consequences which could affect the quality of survivor. So to identify neural developmental status of the EUGR preterm infants,to evaluate prognosis and to deal with in time have a important clinical significance. This study was carried out continuous bed brain function monitoring for preterm infants with EUGR in NICU in order to observe the characteristics of the amplitude integrated electroencephalogram(a EEG)and compare the results with the same corrected gestational age normal infants. We also analyzed the two groups of infants’ magnetic resonance imaging and developmental follow-up in order to study the relationship between EUGR and premature brain neural development and the possible application of a EEG in predicting neural development in preterm infants with EUGR.Method: Preterm infants with EUGR at corrected gestational age 34 weeks, 35 weeks and 36 weeks were included as EUGR group. Preterm infants with gaining normal weight at corrected gestational age 34 weeks, 35 weeks and 36 weeks were included as control group. The hospitalized time of all infants was more than 28 days. The infants with fetal distress, asphyxia, hypoxia-ischemic encephalopathy, severe hyperbilirubinemia, hypoglycemia, severe infections, congenital malformations, mother pregnancy with severe endocrine and metabolic diseases were excluded, such as these factors may cause brain damage. Also infants who died in-hospital, whose radiographic examination revealed intracranial hemorrhage, cerebral edema, periventricular leukomalacia, cerebral infarction, cerebral abscess, hydrocephalus and other brain injury performance were excluded. All the cases were cured or improved. The preterm infants with gaining normal weight had stable vital signs. Their weight, length, head circumference and other various test indexes were in the normal range. Using digital amplitude integration of brain function monitoring(CFM3000), all infants received a EEG monitor at corrected gestational age 34 weeks, 35 weeks and 36 weeks. The duration of each recording was at least 6 hour. The results was judged by blind method. References to Burdjalov scoring system, the scores were calculated to analyzing the graph which included: continuity(Co), sleep-wake cycling(Cy), bandwidth span(Bs) and amplitude of the lower border(LB). All infant received head ultrasound scan every week and magnetic resonance imaging at corrected gestational age of 40 weeks. All infant’s neural development follow-up in 3 months after discharge were collected.Data Statistics: All data is analyzed by the software of Spss 16. 0 and the results are expressed as X ±S. The comparison of two independent sample, T-test was used when normal distribution measurement data was content,Kruska Willis tests was used to compare non parametiric data. Chi-Square was used to compare categorical variables. P<0.05 for the difference was statistically significant.Results:1 Comparing the gestational age, birth weight, corrected gestational ageand weight between two groupsThe gestational age and birth weight between the EUGR group and Normal group had no statistical difference(P>0.05). The corrected gestational age between the EUGR group and Normal group had no statistical difference(P>0.05),but the weight in EUGR group were less than that in Normal group(P<0.05).2 General situation of each group during hospitalizationThere was statistical difference in the average length of hospital stay between EUGR group and Normal group(P<0.05)and were statistical differences in average number of days to lose weight and also in decline percentage of weight between EUGR group and Normal group(P<0.05).Time to start feeding milk in Normal group was shorter than EUGR group(P<0.05). The incidence of anemia and infection in EUGR group were higher than in Normal group(P<0.05). In EUGR group, the average hospitalization time was long, lose weight time last longer, dropped weight percentage was higher, enteral feeding time was later, the incidence of anemia and infection was higher.3 The results of brain function monitoring in each groupThe extrauterine growth retardation group and extrauterine growth normal group was statistically differences.There were statistical differences in the features of a EEG such as continuity,amplitude of the lower border and bandwidth span between EUGR group and Normal group(P<0.05). There was no statistical differences in sleep-wake cycling of a EEG(P > 0.05).4 The results of Magnetic resonance imaging and prognosisEvery infants received magnetic resonance imaging at 40 weeks corrected gestational age or one month after the hospital discharge. 6 infants in EUGR group had enlargement of subarachnoid spaces and delayed myelination. According to developmental follow-up record at 3 months after discharge, 5 infants in EUGR group had development lags behind, higher than the Normal group(P < 0.05).Conclusions:1 In neonatal unit, comparing to Normal preterm infants, preterm infants with EUGR had a longer weight loss time, the higher weight loss percentage. the EUGR infant started enteral feeding difficult, the average hospitalization time was long, the incidence of anemia and infection was higher.2 There were statistical differences in the features of a EEG such as continuity,amplitude of the lower border and bandwidth span between EUGR group and Normal group, it is suggest the brain maturation development in EUGR infants lagged behind normal infants.3 The result of a EEG in predicting neurodevelopmental abnormalities was same to the magnetic resonance imaging and the follow-up records, it suggests the a EEG can be used to earlier prediction of neural development for preterm infants with EUGR. |
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