Abstract:Objective: To explore the clinical significance of early prediction of brain injury in asphyxiated newborns by dynamic changes of serum neuronspecific enolase and amplitude-integrated electroencephalography(aEEG). Methods: Sixtysix fullterm neonates with asphyxia who were hospitalized in NICU, were selected as asphyxia group, and divided into mild asphyxia group (46 cases) and severe asphyxia group (20 cases) according to the degree of asphyxia. Fullterm neonates without asphyxia in the same period were selected as control group (30 cases). The changes of NSE and aEEG were monitored dynamically at three different time points (24 h, 3 d, 7 d after birth and 6 h, 3 d, 7 d after birth). All the children in the asphyxia group were divided into MRI + group and MRI - group according to the results of magnetic resonance imaging. The clinical significance of serum NSE and aEEG in early prediction of brain injury in asphyxiated neonates was evaluated by ROC curve. Results: ① The serum NSE level in severe was significantly higher than that in the control group and in mild asphyxia group at three different time points. ② At 6 h, 3 d and 7 d after birth, aEEG background activity, SWC and SA were correlated with the degree of asphyxia. The correlation coefficient(r) of aEEG background activity, SWC and SA with the degree of asplyxia at 6 h after birth was 0.678, 0.621 and 0.437. The r of aEEG background activity, SWC and SA with the degree of asplyxia at 3 d after birth was 0.739, 0.863 and 0.746, respectively. The r of aEEG background activity, SWC and SA at 7 d after birth was 0.824, 0.869 and 0.847. ③ The degree of asphyxia was associated with the positive rate of MRI(χ2=4.521,P<0.05). ④ The ROC curve was used to evaluate the diagnostic value of changes in serum NSE concentration at three different time points (24 h, 3 d, 7 d). The sensitivity and specificity were the highest in the group of MRI + at 24 h after birth. The sensitivity and specificity were 0.875 and 0.885. When the serum NSE level reached 48.7 μg/L, the diagnostic value was the highest. ⑤ Using ROC curve to predict the positive rate of craniocerebral MRI from normal background activity, maturity of SWC and SA, the changes of aEEG at 6 h and 3 d after birth were of low diagnostic value for early asphyxiated brain injury, and the changes of aEEG at 7 d after birth was of no diagnostic value for asphyxiated brain injury. Conclusion: The dynamic changes of serum NSE and aEEG may be used to monitor and provide early warning of asphyxiated brain injury, and have clinical application value for early prediction of brain injury.
[4]Hellstrm Westas L, Rosén I,Svenningsen NW.Predictive value of early continuous amplitude integrated EEG recordings on outcome after severe birth asphyxia in full term infants \[J\].Arch Dis Child Fetal Neonatal Ed,1995,72(1):F34-F38.
[5]Sousa TMA,Gugelmin VS,Fernandes GM,et al. Comparison of conventional, amplitudeintegrated and geodesic sensor net EEG used in premature neonates: a systematic review \[J\] . Arq Neuropsiquiatr, 2019,77(4):260-267.
[6]HellstrmWestas L. Continuous electroencephalography monitoring of the preterm infant \[J\] . Clin Perinatol,2006,33(3):633-647.
[7]Makropoulos A,Counsell SJ,Rueckert D. A review on automatic fetal and neonatal brain MRI segmentation \[J\] . Neuroimage,2018,170:231-248.
[10]LópezSuárez O,ConcheiroGuisán A,SánchezPintos P,et al. Acylcarnitine profile in neonatal hypoxicischemic encephalopathy:The value of butyrylcarnitine as a prognostic marker\[J\]. Medicine (Baltimore),2019,98(15): e15221.
[11]Massaro AN,Wu YW,Bammler TK,et al. Plasma biomarkers of brain injury in neonatal hypoxicischemic encephalopathy\[J\]. J Pediatr,2018,194 :67-75.
[12]Zhu X,Guo Y,Liu Y,et al. Amplitudeintegrated electroencephalography for early diagnosis and prognostic prediction of hypoxic encephalopathy in preterm infants\[J\]. Med Sci Monit,2018,24:8795-8802.
[13]Boylan GB,Kharoshankaya L,Mathieson SR. Diagnosis of seizures and encephalopathy using conventional EEG and amplitude integrated EEG \[J\]. Handb Clin Neurol,2019,162:363-400.