Early Predictive Value Of The Scoring System Based On Amplitude Integrated Electroencephalogram Combined With The Serum Neuron Specific Enolase In Neonates With Bilirubin Brain Injury

ObjectiveHyperbilirubinemia is a common disease of newborns.Unconjugated bilirubinemia(UCB)can easy pass through blood-brain barrier,causing neuronal damage.Severe UCB may cause bilirubin encephalopathy and lead to permanent neurological dysfunction.The diagnosis of acute bilirubin encephalopathy(ABE)is mainly based on clinical manifestations,magnetic resonance imaging(MRI),serum total bilirubin(TBiL)and brainstem auditory evoked potential(BAEP).But because of the MRI examination need long time and it can't be operated bedside and BAEP can't be carried out owing to its high professional knowledge level in some hospitals,the ABE cannot be found in time.Amplitude integrated electroencephalogram(aEEG)has been refined and is now widely used in the neonate intensive care unit,which is considered a method that cannot be interfered with routine medical care and the output can be interpreted by nonexperts easily.Besides,aEEG can record the sleep-wake cycling(SWC)for a long time bedside.Neuron specific enolase(NSE)is mostly found in nerve cells.When neurons are destroyed,NSE is released into the serum and cerebrospinal fluid,thus,the NSE level can reflect the damage degree of central nervous system.The aim of this study is to evaluate the value of aEEG scores combined with the level of the serum NSE in the early prediction of brain damage in neonates caused by hyperbilirubinemia.Methods1.80 cases neonates with hyperbilirubinemia who were hospitalized in the neonatal ward of Subei People's Hospital were included from March 2017 to February 2018.All patients were full-term infants within one week,of whom with hypoglycemia,asphyxia,severe infection,septicemia,intracranial hemorrhage,central nervous system infection and hemolysis,congenital malformation,the history of ototoxicity or sedative drug use,the history of family deafness,and the clinical manifestation of typical bilirubin encephalopathy were excluded.We Selected 40 healthy neonates born in maternity department of Subei People's Hospital at the same period as the normal control group.2.The basic data of the subjects were collected,including gender,age in days of admission,gestational age,birth weight,body length,head circumference,chest circumference,parity and secondary birth.3.The serum TBiL and NSE were examined by 2ml venous blood immediately after admission to the hospital.aEEG and BAEP were monitored in 24 hours and the head MRI examination was conducted within one week after admission.4.Statistical software SPSS 21.0 and Medcalcl5.8 were used for statistical analysis.Resuts1.Of all the 120 infants enrolled in the study,37 with bilirubin brain injury,43 without bilirubin brain injury,40 were the normal control group.There were no statistical significance among the three groups about gender,age in days of admission,gestational age,birth weight,body length,head circumference,chest circumference(both P>0.05),have comparability.2.The differences of TBiL,NSE and aEEG scores among the three groups were statistically significant(F= 10.868,42.172,50.367,both P<0.01).The level of serum TBiL and NSE in bilirubin brain injury group were higher than those of the infants without bilirubin brain injury group and the normal control group,the difference was statistically significant(P<0.01),while the aEEG scores were lower than those of the infants without bilirubin brain injury group and the normal control group,the difference was statistically significant(P<0.01).The level of serum TBiL in the infants without bilirubin brain injury group was higher than those of the normal control group,the difference was statistically significant(P<0.01),but the serum NSE level and the aEEG scores had no significant difference compared with the normal control group(P>0.05).3.The level of NSE was positively correlated with BAEP(r=0.685,P<0.01),and the aEEG scores was negatively correlated with BAEP(r=-0.718,P<0.01).The degree of aEEG was positively correlated with BAEP(r=0.647,P<0.01).All of them had good correlation and had statistical significance.4.Draw the ROC curves of NSE,aEEG scores and aEEG scores combined with NSE.The area under the three curves was 0.853,0.875,0.938 respectively and the corresponding sensitivity was 0.622,0.865,0.838 respectively and the specificity was 0.93,0.744 and 0.907 respectively.The threshold values of NSE and aEEG scores were 42.34?g/L and 9.5 points respectively.Conclusions1.The higher the level of the serum TBiL,the greater probability of early brain damage caused by bilirubin neurotoxicity,but the single level of serum TBiL cannot be used directly as an indicator of the evaluation of bilirubin brain damage.2.The serum NSE level was positively correlated with BAEP(r=0.685,P<0.01),and the aEEG scores was negatively correlated with BAEP(r=-0.718,P<0.01);aEEG degree was positively correlated with BAEP(r=0.647,P<0.01),and all of them were the indicators of the early prediction of bilirubin brain damage.The higher the level of NSE,the greater the degree of aEEG and the lower scores of the aEEG,the more severe of the bilirubin brain injury.3.Compared with the area under the ROC curve of aEEG scores and the serum NSE,the area under the ROC curve of aEEG scores combined with the serum NSE was the largest.The early prediction of bilirubin brain injury of aEEG scores combined with NSE were more valuable than the single serum NSE level or aEEG scores,which is significant for clinical diagnosis and treatment.