Objective To analyze the change trend and characteristics of neuron specific enolase (NSE), amplitude integrated electroencephalograghy (aEEG) and video electroencephalogram (VEEG) in term infants, in order to provide clinical reference for assessing brain injury and brain function changes in term infants with different blood glucose levels. Methods A total of 83 full-term neonates diagnosed with neonatal hypoglycemia were selected from the Affiliated Hospital of Weifang Medical College from January to August 2019.According to the minimum blood glucose level, the objects were divided into mild hypoglycemia group (39 cases)(2.2 mmol/L≤blood glucose<2.8 mmol/L), moderate hypoglycemia group(31 cases) (1.1 mmol/L≤blood glucose<2.2 mmol/L) and severe hypoglycemia group(13 cases) (blood glucose<1.1 mmol/L).Meanwhile, 40 neonates with normal blood glucose with high risk factors were selected as control group.Children with hypoglycemia were tested every 3 hour.aEEG was performed 6 hours after that two consecutive blood glucose tests were in normal range.Newborns in control group were given 6 hours of aEEG in 72 hours.VEEG was detected in both groups within 12 hours after aEEG.Serum NSE levels were measured on the 1st, 3rd and 5th day.Rank sum test was used for aEEG and VEEG, t test was used for the change of NSE, and F test was used for intergroup comparisons. Results 1) The incidence of pregnancy-induced maternal blood glucose elevation was statistically significant among each group (P=0.03).2) The level of NSE in neonates with hypoglycemia was higher.There were significant differences on NSE level among children with different blood glucose levels (F=965.759, P<0.001), and there was an interaction effect on NSE level between time and blood glucose values (F=31.14,P<0.001).3)There were significant differences on sleep-wake cycle(SWC) and total score of aEEG among mild, moderate and severe hypoglycemia groups (H=25.192,17.824, P<0.01).The total score, SWC and bandwidth in severe hypoglycemia group were significantly lower than those of control group(U=113.0, 111.5, 188.0), and the total score and SWC were lower than those in mild hypoglycemia group (U=132.5, 110.5,P<0.05).The total score and presence of cyclic changes in electrical activity of moderate hypoglycemia group were significantly lower than those of control group (U=366.0, 348.5)and mild hypoglycemia group (U =420.5, 344.5, P<0.05).4) VEEG result was normal in all groups. Conclusions NSE level is different in children with different blood glucose levels, which can be used as an index to evaluate the possibility and degree of brain injury in children with simple hypoglycemia.Moderate and severe hypoglycemia can lead to changes in neonatal aEEG, mainly in SWC changes.However, VEEG can not be a sensitive index for hypoglycemia.
Key words
hypoglycemia /
neuron specific enolase /
amplitude integrated electroencephalograghy /
video electroencephalogram /
term infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Thomton PS,Stanley CA, De Leon DD,et al.Recommendations from the pediatric endocrine society for evaluation and management of persistent hypoglycemia in neonates,infants,and children[J].J Pediatr, 2015,167(2):238-245.
[2] Voormolen DN,de Wit L,van Rijin BB,et al.Neonatal hypoglycemia following diet-controlled and insulin-treated gestational diabetes mellitus[J].Diabete Care, 2018,41(7):1385-1390.
[3] Shahrokhi N,Soltani Z,Khaksari M,et al.The serum changes of neuron-specific enolase and intercellular adhesion molecule-1 in patients with diffuse axonal injury following progesterone administration:a randomized clinical trial[J].Arch Trauma Res, 2016,5(3):37005-37008.
[4] Wight N,Marinelli KA.ABM clinical protocol#1:guidelines for blood glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates revised 2014[J].Breastfeed Med, 2014,9(4):173-170.
[5] Tin W.Defining neonatalhypoglycemia:a continuing debate[J].Semin Fetal Neonatal Med, 2014,19(1):27-32.
[6] Burdjalov VF,Baumgart S,Spitzer AR.Cerebar function monitoring:a new socring system for the evaluation of brain maturation in neonates[J].Pediatrics, 2003,112(4):855-861.
[7] 赵赛,程怀平,田兆芳.新生儿低血糖的临床表现与危险因素研究[J].中国妇幼保健,2015,30(23):3995-3997.
[8] 严文康,马海然,张坤尧.新生儿期低血糖患儿发生早期神经系统发育迟缓的影响因素分析[J].中国实用医药,2019,14(19):77-79.
[9] 臧丽娇,仇杰,庄根苗,等.血清S100B蛋白、神经元特异性烯醇化酶与新生儿低血糖脑损伤的相关性[J].山东大学学报:医学版,2016,54(4):51-54.
[10] Calderon LM,Guyette FX,Doshi AA,et al.Combining NSE and S100B with clinical examination findings to predict survival after resuscitation from cardiac arrest[J].Resuscitation, 2014,85(8):1025-1029.
[11] 杨艳辉,崔凯.血清HMGB1、IGF-1、NSE在新生儿低血糖脑损伤中的变化及应用价值[J].中国妇幼保健,2018,33(22):5171-5174.
[12] 唐振,欧阳志翠,胡呐,等.足月新生儿不同血糖水平振幅整合脑电图特征[J].中华新生儿科杂志,2018,33(6):427-431.
[13] 王璐.新生儿视频脑电图的临床应用价值[J].实用心脑肺血管病杂志,2010,18(9):1306-1308.
[14] 刘晓燕.临床脑电图学[M].2版.北京:人民卫生出版社,2017:625-629.