Rearch On Evaluating And Predicting The Prognosis Of Neonatal Asphyxia In Tibet Through Studying Amplitudeintegrated Electroencephalogram(aEEG)

objective: To investigate the correlation between amplitudeintegrated electroencephalogram(a EEG)and the degree of asphyxia in full-term newborns in Tibet and its relation with prognosis by studying the cerebral electrical activity,a EEG background activity and sleep cycle of full-term asphyxia newborns in 12 h and 10 days after birth,respectively,and follow-up the development of newborns in a month,three months and six months,respectively,in order to provide theoretical basis for clinical treatment and intervention.Methods: Seventy-five full-term asphyxial newborns in NICU(Neonatal Intensive Care Unit)of Tibet autonomous region people's hospital from September 2018 to October 2019 were taken as the research objects.They were divided into mild asphyxia group and severe asphyxia group according to Apgar scores.Besides,40 full-term non-asphyxia Tibetan newborns of the same period were chosen as the control group.a EEG was recorded for the three groups of patients in 12 h and 10 days after birth,respectively,and the newborns with abnormal EEG 10 days after birth were followed-up to see their development in one month,three months and six months,respectively.DDST(Denver developmental screening test)and MRI(magnetic resonance imaging)were adopted to evaluate the development of the newborn.Finally,conclusions were drawn through statistical treatment.a EEG results were judged from four aspects,including cerebral electrical activity,background activities(including five types: continuous normal voltage,discontinuous normal voltage,burst suppression,continuous normal voltage,flat trace),sleep-waking cycle(including three types: no-sleep waking cycle,immature sleep-waking cycle,mature sleep-waking cycle),and epileptic activity(including three types: single attack,repeated attacks,status epilepticus).SPSS17.0 was applied for statistical analysis.Results: There were 31 cases in mild asphyxia group: including 1 case(3.2%)of HIE(hypoxic-ischemic encephalopathy),30 cases(96.8%)of non-HIE,respectively;while 44 cases in severe asphyxia group: 7 cases(15.9%)of non-HIE,respectively.13 cases(29.6%)of mild HIE,17 cases(38.6%)of medium HIE,and 7 cases(15.9%)of severe HIE.There was a correlation between the degree of asphyxia and a EEG results(cerebral electrical activity),background activity,SWC,and SA(seizure activity)(Spearman correlation coefficients are respectively 0.814/0.674,0.724/0.682,0.526/0.582,0.216,all of P<0.05).The more severe asphyxia,the worse the a EEG res ults and the a EEG background activity;the greater the degree of as phyxia,the less mature the SWC;the more serve asphyxia,the more likely the occurrence of SA.The motor development of 110 child ren was followed up at 1 month,3 months and 6 months after birth.The results of 37 cases in the control group and 37 cases in the absence of HIE group were all normal.While the 36 cases in HIE group,22 cases(61.1%)were normal and 14 cases(38.9%)were abnormal,the later including 8 cases with mildly abnormal(psych omotor developmental retardation)and 6 cases with severely abnorm al(epilepsy with severe psychomotor developmental retardation).The 10 cases with severe a EEG abnormalities were all abnormal.As for the 100 cases with non-severe a EEG abnormalities,96 cases(96%)were followed up as normal,and 4(4%)were followed up as abnormal.The positive predictive value of a EEG in the prognosis of asphyxia was 100% while the negative predictive value was 96%,the sensitivity was 71.4% while the specificity was 100%.The re were 2 cases of 4 SA patients were discharged automatically,inc luding 1 case(50%)had mild abnormal prognosis,1 case(50%)ha d severe abnormal prognosis.All cases with SA had abnormal prog nosis.As statistical analysis shows,there was a correlation between a EEG results and prognosis(Somers' d values are respectively 0.563?0.819,P<0.001).The more abnormal the a EEG results,the wor se the prognosis;and the worse the a EEG background activity,the worse the prognosis.Immature and no SWC indicated poor prognos is,and cases with epileptic discharge had worse prognosis.Conclusion: 1.a EEG results(cerebral electrical activity)can reflect the degree of asphyxia.The more severe the asphyxia,the more abnormal the a EEG results;the more severe the asphyxia,the worse the a EEG background activity;the more severe the asphyxia,the prognosis was.Immaturity and absence of SWC indicate poor prognosis;2.a EEG has a good predictive ability for the prognosis of children with asphyxia;3.a EEG epileptic discharge indicates severe asphyxia and poor prognosis.