| Objectives:To explore the sensitive indexes which can reflect the changes of brain function in premature infants by dynamic monitoring of postnatal Amplitude-Integrated electroencephalogram(aEEG)and magnetic resonance imaging(MRI)in preterm infants with different gestational age(GA).And the time window of brain injury and nerve recovery to find the most suitable examination time to predict the brain injury and neurological prognosis of premature infants by comprehensive means.Methods:From December 2017 to December 2018,73 premature infants who were born in Handan Central Hospital or transferred from other hospitals within 72hours after birth were selected as subjects.According to the results of MRI,the subjects were divided into two groups:brain injury group and non-brain injury group.The brain injury group included intraventricular hemorrhage(IVH),periventricular leukomalacia(PVL)and periventricular hemorrhagic infarction(PHI).The results of aEEG and MRI in preterm infants were analyzed.According to different birth GA,the subjects were divided into two subgroups:GA<33 weeks group and 33 weeks?GA<37 weeks group,and the data of perinatal period of preterm infants were collected respectively.The preterm infants included in the study were monitored with Nicolet one cerebral function monitor(CFM)for the first time within 72 hours after birth,then monitored every 2 weeks until leave hospital,and monitored continuously for 4 hours each time to observe the waveform characteristics.The background continuity,sleep-wake cycling,lower boundary amplitude and bandwidth of aEEG were analyzed,and the development of brain function in each group was compared.The preterm infants in the group were examined by head MRI before leave hospital,and the neurodevelopment outcome and aEEG characteristics of premature infants were analyzed statistically to explore the correlation between the imaging changes and neonatal nervous system prognosis in different degrees.Results:(1)Background activity continuity chi-square test and sleep-wake cycling Chi-square test were used in aEEG monitoring of premature infants in the two groups(?~2=12.47,P<0.01),and in sleep-wake cycling(?~2=6.67,P<0.05).The lower boundary voltage:t-test of premature infants without sleep-wake cycling(F=2.14,P<0.01),QS stage t-test for preterm infantswith sleep-wake cycling(F=0.58,P<0.01),AS stage t-test(F=3.05,P<0.01).Bandwidth:QS stage t-test(F=6.58,P<0.01),AS stage t-test(F=10.95,P<0.01).(2)aEEG combined with MRI could sensitively detect brain injury in premature infants.There was no significant difference between the monitoring results of aEEG and MRI at 2 weeks after birth in the group of GA<33 weeks(?~2=0.49,P?0.05).There was no significant difference between the monitoring results of aEEG and the results of MRI within 72 hours after birth in the group of 33 weeks?GA<37 weeks(?~2=0.24,P?0.05).(3)The aEEG maturity of preterm infants in the two groups was influenced by gestational age and postconceptional age.With the increase of gestational age and postconceptional age,the continuity of aEEG background activity and the percentage of sleep-wake cycling increased gradually.The continuous voltage appears gradually,the lower boundary voltage increases gradually,and the bandwidth becomes narrower.The percentage of continuous voltage and the occurrence rate of sleep-wake cycling in preterm infants with postconceptional age and the same gestational age increased significantly,while the lower boundary voltage increased and the bandwidth narrowed.(4)Logistic regression analysis showed that:sex,gestational age,birth weight,mode of delivery,abnormal placental membrane and umbilical cord,maternal abortion history,maternal diabetes mellitus,maternal hypertension.These factors was no significant difference in the two groups(P?0.05).Conclusions:(1)Compared with the non-brain injury group,the aEEG background activity continuity,sleep-wake cycling frequency,lower boundary voltage and wide bandwidth in brain injury group were lower than those in non-brain injury group.(2)The most suitable time of aEEG monitoring for preterm infants GA<33weeks was 2 weeks after living,and the most suitable monitoring time for preterm infants 33 weeks?GA<37 weeks was within 72 hours after living.(3)The older the gestational age was,the more mature the expression of aEEG was.The maturity of aEEG was positively correlated with the gestational age and postnatal age.In the same corrected gestational age,the preterm infants with younger gestational age were more mature than those with older gestational age.That is,extra-uterine birth accelerated the brain development of premature infants. |
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