Abstract: Objective To perform the amplitude integrated electroencephalogram (aEEG) for neonates with asphyxia, and to analyze the correlation between aEEG score and hypoxic-ischemic encephalopathy (HIE) severity, so as to provide reference for early clinical diagnosis of HIE and severity assessment. Methods A retrospective analysis was conducted on 88 cases of asphyxia neonates with gestational age ＞35 weeks who were admitted to the Neonatal Department of Nanjing Maternity and Child Health Hospital from July 2014 to December 2020 and underwent bedside Cerebral Function Monitor(CFM) examination within 12 hours after birth.The neonates were divided into normal group (n=10), mild HIE group (n=30), moderate HIE group (n=32) and severe HIE group (n=16).The risk factors of severe HIE were analyzed.Compressed aEEG recordings were obtained by CFM examination and four parameters of aEEG patterns were evaluated and scored, including continuity(Co), cycling(Cy), amplitude of lower border(LB), bandwidth span and amplitude of lower border(B), and the total score(T) was added up.The correlation between each parameter and HIE severity was analyzed.After HIE cases were treated with hypothermia, cerebral function was reviewed and the aEEG scores of each group were compared again.Fifty-five babies completed cranial MRI examination, and the difference of MRI severity among HIE groups was compared. Results There were significant differences in gestational age, pH value of the first postnatal blood gas analysis between the severe HIE group and other HIE groups(H=11.104, F=3.725, P＜0.05).The cesarean section rate in normal group was higher than that in other groups (Fisher's exact probability, P=0.031).The lower scores of Co, Cy, LB, B and T of aEEG indicated more severe HIE, and the negative correlation was significant (r=-0.531, -0.529, -0.423, -0.468, -0.487, P＜0.05).After HIE cases were treated with hypothermia, aEEG scores among each group were significantly improved.But the aEEG total score of the severe HIE group was still significantly different from that of the mild and moderate HIE groups (F=5.972, P<0.001).There was no significant difference in MRI severity among different HIE groups(P＞0.05). Conclusions aEEG scoring system can early diagnose and predict the severity of HIE in asphyxia neonates with brain function monitoring, which can be used as a tool to evaluate the severity of HIE.Hypothermia therapy can improve the cerebral function of HIE patients.

Key words: amplitude-integrated electroencephalogram, aEEG scoring system, neonatal asphyxia, hypoxic-ischemic encephalopathy

摘要： 目的 对窒息新生儿进行振幅整合脑电图(aEEG)评分,分析aEEG与缺氧缺血性脑病(HIE)严重度的相关性,以期为临床早期诊断HIE及严重度判断提供参考依据。方法 回顾分析2014年7月-2020年12月南京市妇幼保健院新生儿科收治住院的胎龄35周以上并在生后12 h内进行床旁脑功能监测的窒息新生儿88例,分为正常组10例,轻度HIE组30例,中度HIE组32例,重度HIE组16例,分析发生重度HIE的高危因素。获取振幅整合脑电图(aEEG)图形并分析aEEG图形的4个参数:连续性(Co)、周期性(Cy)、下边界振幅(LB)和带宽(B)分别进行评分,相加得总分(T),观察每个参数与HIE严重度之间的相关性。HIE患者亚低温治疗后复查脑功能,再次比较各组aEEG得分情况。55例患儿完成头颅MRI检查,比较HIE各组间MRI严重度的差异。结果 重度HIE组的胎龄、生后第1次血气分析pH值与HIE其余各组比较,差异有统计学意义(H=11.104,F=3.725,P<0.05);正常组剖宫产率高,与其他各组比较,差异有统计学意义(Fisher精确概率,P=0.031);aEEG的Co、Cy、LB、B和T分值越低,HIE越严重,均与HIE严重度显著相关(r=-0.531、-0.529、-0.423、-0.468、-0.487,P＜0.001);HIE患者亚低温治疗后,各组aEEG总评分均增加,但重度HIE组aEEG总得分与轻、中度HIE组差异仍有统计学意义(F=5.972,P>0.05)。MRI严重度在HIE各组间差异无统计学意义(P=0.125)。结论 对窒息新生儿进行脑功能监测,aEEG评分系统能早期诊断和预测HIE病情轻重程度,亚低温治疗能改善HIE患者脑功能。

关键词: 振幅整合脑电图, 评分系统, 新生儿窒息, 缺氧缺血性脑病