【摘要】 目的 探讨出生后3 h及3 d振幅整合脑电图(aEEG)联合出生后2周头颅磁共振成像(MRI)对晚期早产儿矫正胎龄40周时神经行为发育异常的预测价值。方法 选择2021年1月至2022年12月新乡医学院第一附属医院新生儿科收治的60例晚期早产儿为研究对象，患儿出生后即转入本院新生儿重症监护室进行治疗并行aEEG监测，每天监测至少3 h,连续监测3 d;于出生后2周时行头颅MRI检查，并于矫正胎龄40周时进行新生儿行为神经检查(NBNA)评分。采用Kruskal-Wallis H检验分析aEEG分级、头颅MRI检查颅内出血(ICH)分级和脑白质损伤(WMD)分级与NBNA评分的一致性；采用受试者操作特征曲线、敏感度、特异度、阴性预测值、阳性预测值评估aEEG及头颅MRI对神经行为发育异常的预测价值。结果 60例晚期早产儿中，NBNA评分>35分43例，≤35分17例；出生3 h时aEEG正常4例(6.7%),轻度异常29例(48.3%),重度异常27例(45.0%);出生3 d时aEEG正常21例(35.0%),轻度异常24例(40.0%),重度异常15例(25.0%);ICH分级：无出血27例(45.0%),Ⅰ～Ⅱ度ICH 26例(43.3%),Ⅲ～Ⅳ度ICH 7例(11.7%);WMD分级：无白质损伤31例(51.7%),轻中度损伤22例(36.7%),重度损伤7例(11.7%)。出生后3 h、3 d时aEEG分级与NBNA评分具有显著一致性(H=6.790、20.200,P<0.05);且ICH分级、WMD分级与NBNA评分之间具有显著一致性(H=20.374、14.591,P<0.05)。出生后3 h、3 d aEEG单独或联合出生后2周头颅MRI对矫正胎龄40周时神经行为发育异常均有预测价值(P<0.05)。单独出生3 d aEEG分级预测神经行为发育异常的曲线下面积(AUC)显著大于出生3 h aEEG分级(P<0.05);单独出生后2周头颅MRI预测神经行为发育异常的AUC大于出生后3 d aEEG分级(P<0.05);aEEG联合头颅MRI对早产儿神经行为发育异常的AUC大于单独aEEG、头颅MRI,且出生后3 d aEEG联合出生后2周头颅MRI对晚期早产儿矫正胎龄40周龄神经行为发育异常的AUC最大(P<0.05)。结论 早期aEEG分级与MRI检测相结合可提高对晚期早产儿神经发育异常的预测价值。更多还原

【Abstract】 Objective To investigate the predictive value of amplitude-integrated electroencephalogram(aEEG) at 3 hours and 3 days after birth combined with cranial magnetic resonance imaging(MRI) at 2 weeks after birth for abnormal neurobehavioral development of late preterm infants at a corrected gestational age of 40 weeks.Methods Sixty late preterm infants admitted to the Department of Neonatology, the First Affiliated Hospital of Xinxiang Medical University from January 2021 to December 2022 were selected as the research subjects.After birth, the infants were transferred to the neonatal intensive care unit of our hospital for treatment and aEEG monitoring, aEEG was monitored once a day for at least 3 hours each time and continued for 3 days; cranial MRI examination was performed at 2 weeks after birth, and neonatal behavioral neurological assessment(NBNA) score of the children was performed at 40 weeks of corrected gestational age.The consistency between aEEG grading, intracranial hemorrhage(ICH) grading and white matter injury(WMD) grading by cranial MRI examination with NBNA grading was analyzed by using Kruskal Wallis H-test; the predictive value of aEEG and cranial MRI for neurobehavioral dysplasia was evaluated by receiver operating characteristic curve, sensitivity, specificity, negative predictive value and positive predictive value.Results Among the 60 late preterm infants, there were 43 cases with NBNA score>35,17 cases with NBNA score≤35;on the 3 hours after birth, 4 cases(6.7%) had normal aEEG,29 cases(48.3%) had mildly abnormal aEEG,and 27 cases(45.0%) had severely abnormal aEEG;on the third day after birth, 21 cases(35.0%) had normal aEEG,24 cases(40.0%) had mild abnormal aEEG,and 15 cases(25.0%) had severe abnormal aEEG;according to ICH grade, there were 27 cases(45.0%) without bleeding, 26 cases(43.3%) withⅠ-Ⅱ degree of ICH,7 cases(11.7%) with Ⅲ-Ⅳ degree of ICH;according to WMD grade, there were 31 cases(51.7%) with no white matter injury, 22 cases(36.7%) with mild to moderate injury, and 7 cases(11.7%) with severe injury.The aEEG grading at 3 hours and 3 days after birth was significantly consistent with the NBNA score(H=6.790,20.200;P<0.05);and there was a significant consistency between ICH grading, WMD grading and NBNA score(H=20.374,14.591;P<0.05).The aEEG at 3 hours and 3 days after birth alone or in combination with cranial MRI at 2 weeks after birth had predictive value for abnormal neurobeha-vioral development at a corrected gestational age of 40 weeks(P<0.05).The area under the curve(AUC) of aEEG grading at 3 days after birth in predicting neurodevelopmental abnormalities was significantly greater than that of aEEG grading at 3 hours after birth(P<0.05);the AUC of cranial MRI at 2 weeks after birth in predicting neurodevelopmental abnormalities was significantly greater than that of aEEG grading at 3 days after birth(P<0.05);the AUC of aEEG combined with cranial MRI in predicting neurodevelopmental abnormalities of preterm infants was significantly greater than that of aEEG or brain MRI alone, and the AUC of aEEG at 3 days after birth combined with cranial MRI at 2 weeks after birth in predicting the neurodevelopmental abnormalities of late preterm infants at a corrected gestational age of 40 weeks was the largest(P<0.05).Conclusion The combination of early aEEG grading and MRI can improve the predictive value for neurodevelopmental abnormalities of late preterm infants.更多还原