Correlation Of Amplitude Integrated EEG?Biochemical Makers And Pathophysiology And Prognosis Of Preterm Infant With Germinal Matrix-Intraventricular Hemorrhage

Objective:With the neonatal intensive care unit technology continues to improve,survival rates of premature infants have dramatically increased.But a large part of survival premature infants combined with hemorrhagic brain injury due to various pathological factors of prenatal,perinatal or postnatal.Corresponding symptoms and signs of intracranial hemorrhage may arise in the clinical early,the severe can lead to long-term nervous system sequelae even death.Germinal matrix-intraventricular hemorrhage(GM-IVH)remains the most common form of intracranial hemorrhage in premature infants.Its incidence is inversely proportional to gestational age,birth weight and other factors,associated with immature angiogenesis in preterm children,poorly cerebrovascular autoregulation and early hypoxia factors after birth.Vascular endothelial growth factor(VEGF)play an important role in tissue hyperplasia,embryonic development,wound healing and angiogenesis,brain-derived nerve growth factor is a nutrition protein in promoting nerve cell growth and activity,the two may be related with the occurrence and prognosis of intraventricular hemorrhage.As a basis for early intervention and prevention,early diagnosis of intracranial hemorrhage is very important,in this study,amplitude-integrated EEG(aEEG)applyed in neonatal intensive care for preterm children bedside brain monitoring,comparing and analysissing with cranial ultrasound,magnetic resonance imaging(MRI)findings,meanwhile compared serum VEGF,BDNF at different times between intracranial hemorrhage group and without intracranial hemorrhage group,follow-up neural development of this part of preterm,investigating value of aEEG in diagnosis and prediction intracranial hemorrhage and neurodevelopmental inpreterm children,exploring the relationship between VEGF,BDNF concentration at different time periods and intracranial hemorrhage and nerve prognosis to providing new evidence for clinical diagnosis and intervention.Methods:Preterm infants with gestational age(GA)<34 weeks,admitted to the Bethune International Peace Hospital neonatal intensive care unit after birth from May 2014 to October 2015 were recruited for this study.The infants with central nervous infection,brain development deformity,periventricular leukomalacia,and metabolic diseases were excluded.A total of 86 cases were collected,including 41 cases of normal group and 45 cases of premature infants with intracranial hemorrhage.Using digital amplitude integration of brain function monitoring(CFM3000),all preterms received aEEG monitor.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).Getting “difference” which definited as actual aEEG score minus corresponding gestational age aEEG score.All infant received bedside head ultrasound scan within 24-72 hours and once a week in following time,according to the situation accepted magnetic resonance imaging atcorrected gestational age of 36-40 weeks or follw-up,record all test results.All preterms' neural development follow-up near 12 months after discharge were collected.Specialized nursing took the venous blood 1ml and centrifuged at room at room temperature at 24 hours,7days after borth.The supernatant fluid200 ul was stored at-20°C for inspection.VEGF and BDNF concentration were measured by enzymelinked immunosorbent assay-sandwich technique(ELISA).Data Statistics: All data is analyzed by the software of Spss 13.0 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,Rank-sum tests was used to compare ranked data.Chi-Square was used tocompare categorical variables.P<0.05 for the difference was statistically significant.Results:1 Comparation of the gestational age,birth weight,head circumference,gender and mode of delivery between the IVH preterm group and normal group had no statistical difference(P>0.05).2 Comparing the diagnosis value of aEEG for GM-IVHNormal preterm group a EEG abnormality rate and IVH group infants AEEG abnormality rate was statistically significant(?2=7.274,P=0.007<0.05).Mild IVH preterm group aEEG abnormality rate and control group aEEG abnormality rate had no significant difference(?2=0.948,P=0.330> 0.05).The abnormal rate of aEEG between severe IVH preterm group and control group was significantly different(Fisher exact probability method,P =0.000<0.01).The aEEG score difference of control group was 0.097±1.157,aEEG score difference of mild IVH preterm group was-0.312 ± 1.060,two groups compared had no statistical difference(P>0.05).Severe brain injury group aEEG score difference was-5.15 ± 1.068,there was significant difference compared with the control group(P=0.05).3 Comparison of a EEG and MRI in predicting prognosis of intracranial hemorrhageIn total 34 cases follow-up in the control group,6 cases were lower-middle intelligence,0 case of low intelligence;29 cases of mild IVH preterm infants followed up,8 cases were lower-middle intelligence,3 cases of low intelligence;two groups of neuropsychological development of children aged 0-6 years old were statistically significant difference(Z=-2.474P=0.013<0.05).Most of severe intracranial hemorrhage patients lost to follow-up,were not analyzed statistically.The aEEG abnormality rate compared between mild IVH preterm group and control group had no significant difference(?2=0.948,P=0.330>0.05).The MRI anomaly rate pared between mild IVH group and control group had a statistically significant difference(?2=5.559,P=0.018<0.05).The sensitivity of aEEG in predictingthe prognosis of mild IVH was 85%,specificity was 66%.The sensitivity of MRI in predicting the prognosis of mild IVH was 80%,the specificity was75%.4 Correlation between serum VEGF,BDNF and prognosis in premature infants.In the IVH group the serum levels of VEGF at 7 days were higher than those at 24 hours,both of them were higher than the control group.The VEGF level at 7 days was lower than those at 24 hours in control group.In IVH group serum levels of BDNF at 24 hours were lower than the 7 days,both were lower than control group.The content of serum VEGF Within 24 hours was positively correlated with poor neural prognosis,the content of serum BDNF within 24 hours was negatively correlated with poor neural prognosis.Conclusions:1 The aEEG pattern within 72 hours after birth in predicting preter m with severe GM-IVH is meaningful,no obvious difference between n ormal preterm and mild IVH.2 According to early aEEG score difference could evaluate probabil ity of occurrence IVH among different gestational weeks premature;a E EG sensitivity was higher than MRI in predicting mild IVH prognosis,but specific was lower.3 Early aEEG normal in I and II degree IVH cannot be excluded nervous system abnormalities,should further improve the MRI.4 High level of VEGF is related to poor prognosis of premature w ith IVH;BDNF plays neuroprotective role in preterm infants with IVH.