目的 分析早期振幅整合脑电图(aEEG)对重度高胆红素血症新生儿神经发育结局的预测作用。方法 选择2016年12月-2018年12月恩施州中心医院新生儿重症病房收治的86例重度高胆红素血症新生儿为研究对象。记录患儿基本临床特征,所有患儿均接受aEEG、MRI或听觉脑干反应(ABR)检查,并连续随访12个月,评估患儿神经发育结局。结果 在随访的72例(83.7%)患儿中,有16例(22.2%)患儿出现不良神经发育结局。与神经发育良好结局患儿比较,不良发育结局患儿总血清胆红素水平、总血清胆红素/血清白蛋白比值、神经功能障碍(BIND)得分>3比例、交换输血比例显著升高(P<0.05)。单独aEEG、ABR异常检查结果、aEEG联合ABR及MRI联合ABR异常检查结果均与患儿不良神经发育结局显著相关(P<0.05)。Logistic回归分析结果示,aEEG异常(OR=6.898,95%CI:1.047~45.563)和ABR异常(OR=16.998,95%CI:2.685~107.608)是患儿不良神经发育结局的重要危险因素。异常aEEG和异常ABR对新生儿不良神经发育结局预测的灵敏度为56.25%、85.71%,特异度为91.07%、73.33%,准确度为83.33%、77.27%,阳性预测值为64.29%、60.00%,阴性预测值为87.93%、91.67%。结论 早期aEEG可预测重度高胆红素血症新生儿的不良神经发育结局,特异性高,但敏感性低于ABR。
Abstract
Objective To explore the predictive value of early amplitude integrated electroencephalography (aEEG) on neurodevelopmental outcomes in neonates with severe hyperbilirubinemia. Methods A total of 86 neonates with severe hyperbilirubinemia admitted to the neonatal intensive care unit of Enshi Central Hospital from December 2016 to December 2018 were selected as the research subjects.The basic clinical characteristics of the children were recorded.All children underwent aEEG, MRI, or auditory brainstem response (ABR) examination, and were followed up for 12 consecutive months to evaluate the neurodevelopmental outcomes of the children. Results Among the 72 (83.7%) children who were followed up, 16 (22.2%) children had adverse neurodevelopmental outcomes.Compared with children with good neurodevelopmental outcomes, children with poor developmental outcomes had significantly higher total serum bilirubin level, total serum bilirubin/serum albumin ratios, BIND scores>3, and exchange transfusion rates (P<0.05).The results of abnormal aEEG, ABR examinations, and the results of aEEG combined with ABR as well as MRI combined with ABR abnormalities were significantly correlated with adverse neurodevelopmental outcomes in children (P<0.05).Logistic regression analysis showed that aEEG abnormalities (OR=6.898,95%CI:1.047—45.563) and ABR abnormalities (OR=16.998,95%CI:2.685—107.608) were important risk factors for adverse neurodevelopmental outcomes in children.The sensitivity of abnormal aEEG and abnormal ABR to the prediction of neonatal adverse neurodevelopmental outcomes was 56.25% and 85.71%, specificity was 91.07% and 73.33%, accuracy was 83.33% and 77.27%, positive predictive values was 64.29% and 60.00%, and negative predictive value was 87.93% and 91.67%, respectively. Conclusion Early aEEG may predict adverse neurodevelopmental outcomes in neonates with severe hyperbilirubinemia, with higher specificity but lower sensitivity than ABR.
关键词
振幅整合脑电图 /
高胆红素血症 /
神经发育 /
新生儿
Key words
amplitude integrated electroencephalography /
hyperbilirubinemia /
neurodevelopment /
newborn
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参考文献
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基金
湖北省卫生健康委科研项目(WJ2019F139)
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