Bedside video electroencephalogram within 6 hours after birth in diagnosis of perinatal hypoxic-ischemic encephalopathy and prognosis of short-term neural and behavioral development / 中华围产医学杂志

ABSTRACT

Objective To evaluate the diagnostic value of bedside video electroencephalogram (VEEG) in neonatal within 6 h after birth in diagnosing hypoxic-ischemic encephalopathy ( HIE) and the correlation of bedside VEEG results and early neural and behavioral development. Methods Neonatal severe asphyxia cases were collected and bedside VEEG and HIE were recorded and graduated. The sensitivity and specificity of different VEEG degrees within 6 h after birth were calculated in prognosing HIE degree. The sensitivity and specificity of abnormal VEEG performed within 6 h, the third day and the seventh day after birth, respectively, were compared in prognosing HIE. Neonatal behavior neurological assessment (NBNA) was performed at 7 to 14 days of age, EEG and general movements assessment (GMs), developmental screening test for child under six(DST) when patients were 3 months old, and EEG, Bayley scales of infant development(BSID) at 6 months old to analyze the correlation of bedside VEEG results and early neural and behavioral development. Results Forty-eight severe asphyxia neonatal were included, among which 12 severe asphyxia and 36 HIE, including 14 mild, 12 moderate and 10 severe HIE. There were nine normal and 39(81. 3%) abnormal VEEG including 16 mild, 11 moderate, five severe abnormal and seven inactive VEEG within 6 h after birth. There were 32(88. 9%) abnormal VEEG within 6 h after birth in 36 HIE patients. Significant positive correlation was found between VEEG within 6 h after birth and HIE (r= 0.849, P<0. 01). Severe abnormal and inactive EEG within 6 h after birth showed sensitivity of 100%, specificity of 94. 7% in predicting severe HIE. The sensitivity of VEEG testing at 6 h,3 and 7 d in predicting HIE were 88. 9%, 83. 9% and 28. 6% , correspondingly the specificity were 41.7%, 91. 7% and 100%, respectively. Nine patients with continually abnormal VEEG died in hospital. The NBNA scores of patients with moderate and severe abnormal EEG were significantly lower than those with normal EEG (both P<0. 01), the NBNA scores of patients with severe abnormal EEG were significantly lower than those with moderate abnormal EEG (P<0. 05). Thirty-five patients were followed up in the hospital at 3 months old, and 32 patients had DST >85 and three had DST between 70 and 84 with abnormal EEG. GMs assessment of one of the three patients showed absence of fidget movements, cuing a chance of cerebral palsy. Fourteen patients were followed up in hospital at 6 months old, and seven of them had abnormal EEG, four had abnormal BSID with abnormal EEG. Conclusions VEEG within 6 h after birth shows high sensitivity and specificity in prognosing HIE, and much relates to short-term neural and behavior development.