The Application Research Of The Scoring System Of Amplitude-integrated Electroencephalogram (EEG) For Brain Injury In Small For Gestational Age Preterm Infants

Objective: To investigate the sensitivity and value of application of aEEG score in the early diagnosis of brain injury in this newborn and analyze the relationship between aEEG score and the severity of brain damage,and aslo the differences between aEEG scoring system and Naqeed classification in assessing brain injury in SGA preterm infants,this study retrospectively analyzed the characteristics of aEEG in the small for gestational age(SGA)preterm infants with or without brain injury in our hospital neonatology department,and their feature in the aEEG scoring system.Our project was designed to provide the evidence for an earlier and more accurate diagnosis of brain injury in the small for gestational age(SGA)preterm infants.Method: 43 cases of SGA preterm infants with brain injury were selected for the experimental group,50 cases of SGA preterm infants without brain injury were the control group(MRI as gold standard),from our hospital.Both of them were monitored by electroencephalogram at least 4 hours(The aEEG monitoring of these children was completed within 72 hours after admission).Two methods were used to evaluate the results of the EEG of the baby.One of them is the Naqeed classification methods: The aEEG of newborn is divided into normal amplitude,mild abnormal amplitude and severe abnormal amplitude according to the background activities.(1)normal amplitude: amplitude upper boundary>10uv,the lower boundary>5uv;(2)mild abnormal amplitude: amplitude upper boundary>10uv,the lower boundary<5uv;(3)severe abnormal amplitude: amplitude upper boundary<10uv,the lower boundary<5uv,or mild amplitude accompanied by epilepsy.Another of them is the scoring system of aEEG: the continuity,the lower amplitude of the spectral band,the Sleep-wake cycle and the width were taken as indexes to calculate a total score.Statistical analysis was performed using Chi-square test,t-test,Pearson test,Kappa test,and ROC curve analysis.A P-value <0.05 was considered statistically significant.Results:1.The background activity of the children without brain injury gradually became a continuous background pattern with gestational aging.2.Spearman correlation analysis shows:(1)Normal group: amplitude under voltage boundary(R =0.321)?continuous background(R =0.321)?sleep-wake cycle(R =0.701)?bandwidth(R =0.758)?total score(R =0.733),all of them were positively correlated with gestational age,as with the gestational age increasing aslo the above-mentioned scores(2)Disease group: amplitude under voltage boundary(R=0.011)?continuous background(R =0.002)?sleep-wake cycle(R =0.390)?bandwidth(R =0.111)?total score(R =0.196),except there was a correlation between sleep-wake cycle and gestational age,no correlation with several other items.3.To eliminate the differences caused by different gestational age,the total average score of appropriate gestational age minus the single original points taken as corrected points.The total score of the disease group was 6.2523±2.15,normal group total score of 1.00(0.00,2.25),Z=6.842,P<0.01,which shows the higher the corrected score,the greater brain injury.4.By Naqeed classification method: The sensitivity of Naqeed classification method was 76.75%,the specificity was 66%,the misdiagnosis rate was 23.25%,the missed diagnosis rate was34%,and the Gordon index was 0.43.The sensitivity of the Naqeed classification method was 83.73%,the specificity was 84%,the misdiagnosis rate was 16.27%,the missed diagnosis rate was16%,and the Gordon index was 0.67.Results of Kappa test: Naqeed classification method: K=0.423,while the aEEG scoring system: K=0.676.Roc curve analysis: the area under the Naqeed classification method curve is 0.714;and that is 0.839 in the aEEG examinations.Two methods of misdiagnosis rate of chi-square test: X2 = 4.320 a,P = 0.038 <0.05.Conclusions:1.The amplitude,continuity,sleep-wake cycle and bandwidth of aEEG of different gestational age children were gradually developed with gestational aging.While the EEG activity of small for gestational age infants is more immature than the appropriate for gestational age infants,mainly in the LMA is lower,the background activity continuity and SWC appear relatively late,wide amplitude bandwidth.2.In the aEEG scoring system,sleep-wake cycle,bandwidth and total score are the best indicator to evaluate brain development maturity.3.The aEEG score of SGA premature infants whose brain injury was significantly different from that of normal SGA premature infants.Simultaneously,the smaller the aEEG score,the more serious the brain injury.4.The aEEG score method has a lower misdiagnosis rate compared with the Naqeed classification method in small for gestational age preterm infants.The aEEG scoring system has a higher accuracy than that in Naqeed classification in the diagnosing brain damage in SGA premature infants.In addition,the aEEG score was highly consistent with MRI in diagnosing brain damage in these child patients.Thus it has a higher utility value than Naqeed classification for SGA premature infants.