振幅整合脑电图在高原地区住院新生儿中的监测结果分析

Amplitude-integrated electroencephalography monitoring results of hospitalized neonates in plateau areas

摘要:

目的 分析高原地区住院新生儿进行振幅整合脑电图（amplitude-integrated electroencephalography, aEEG）监测的结果。方法 回顾性选取2020年1月—2022年12月在昆明市儿童医院新生儿科住院并接受aEEG监测的5 945例患儿为研究对象，根据aEEG监测结果分为aEEG正常组与aEEG异常组。分析各系统疾病aEEG异常发生率，aEEG异常表现及aEEG异常与临床异常情况的一致性。结果 5 945例患儿中，aEEG异常率为19.28%（1 146/5 945），其中危重患儿异常率29.58%（906/3 063），非危重患儿异常率为8.33%（240/2 882），差异有统计学意义（P<0.05）。aEEG异常率较高的前三位主诊断疾病依次是遗传代谢性疾病60.77%（79/130）、中枢神经系统疾病42.22%（76/180）、早产儿35.53%（108/304）。aEEG异常组日龄及胎龄均小于aEEG正常组，早产儿出生体重低于aEEG正常组（P<0.05）。1 146例aEEG异常患儿中，aEEG异常类型主要有睡眠觉醒周期异常597例（52.09%）、背景活动异常294例（25.65%）和痫样活动255例（22.25%）；有异常临床表现者902例（78.71%）。aEEG监测脑功能异常的灵敏度为33.51%，特异度为92.50%。结论 高原地区住院新生儿尤其是危重儿、胎龄及日龄小的患儿，aEEG异常率较高，提示脑损伤风险也较高，故对住院新生儿常规进行aEEG监测有利于早期发现脑功能异常，有助于决策治疗并做好脑保护策略。

Abstract:

Objective To investigate the amplitude-integrated electroencephalography (aEEG) monitoring results of hospitalized neonates in plateau areas.Methods A retrospective analysis was conducted on 5 945 neonates who were admitted to the Department of Neonatology, Kunming Children's Hospital, and received aEEG monitoring from January 2020 to December 2022. According to the aEEG monitoring results, they were divided into a normal aEEG group and an abnormal aEEG group. The incidence rate of aEEG abnormalities was analyzed in neonates with various systemic diseases, as well as the manifestations of aEEG abnormalities and the consistency between aEEG abnormalities and clinical abnormalities.Results Among the 5 945 neonates, the aEEG abnormality rate was 19.28% (1 146/5 945), with an abnormality rate of 29.58% (906/3 063) in critically ill neonates and 8.33% (240/2 882) in non-critically ill neonates (P<0.05). The children with inherited metabolic diseases showed the highest aEEG abnormality rate of 60.77% (79/130), followed by those with central nervous system disorders [42.22% (76/180)] and preterm infants [35.53% (108/304)]. Compared with the normal aEEG group, the abnormal aEEG group had significantly lower age and gestational age, as well as a significantly lower birth weight of preterm infants (P<0.05). Among the 1 146 neonates with aEEG abnormalities, the main types of aEEG abnormalities were sleep cycle disorders in 597 neonates (52.09%), background activity abnormalities in 294 neonates (25.65%), and epileptiform activity in 255 neonates (22.25%), and there were 902 neonates (78.71%) with abnormal clinical manifestations. The sensitivity and specificity of aEEG monitoring for brain function abnormalities were 33.51% and 92.50%, respectively.Conclusions In plateau areas, there is a relatively high rate of aEEG abnormalities among hospitalized neonates, particularly in critically ill neonates and those with smaller gestational ages and younger ages, suggesting a high risk of brain injury. Therefore, routine aEEG monitoring for the hospitalized neonates can help with the early detection of brain function abnormalities, the decision-making in treatment, and the formulation of brain protection strategies.