تغییرات در سیگنالهای الکتروانسفالوگرافی در نوزادان زودرس با پیامد رشدی-عصبی
Abstract
1- Introduction
2- Methods
3- Results
4- Discussion
5- Conclusion
References
Abstract
Introduction: Recent studies showed that neurodevelopment in preterm infants can be predicted by using amplitude-integrated electroencephalography (aEEG)-derived parameters. In our previous study we demonstrated that aEEG could be useful in predicting neurodevelopmental outcome in very preterm infants at the corrected age of 2 years. Aim: The aim of this study was to further evaluate aEEG for predicting neurodevelopmental outcome at the at the corrected age of 2 years in preterm infants. Methods: Between July 2010 and June 2016 440 very preterm infants were eligible for the study at Innsbruck Medical University Hospital. The aEEG was evaluated for the Burdjalov score in 306 preterm infants (mean gestational age 29.5 weeks; range: 24.1–31.9 weeks). At the corrected age of 2 years outcome was assessed by the Bayley Scales of Infant and Toddler Development. Results: The cohort was divided into three subgroups: 248 infants with normal outcome, 40 infants with delayed outcome and 18 infants with abnormal outcome. Burdjalov scores were lower in infants with delayed outcome than in infants with normal outcome and even lower in infants with abnormal outcome. Post-hoc analysis showed significant differences between normal and delayed psychomotor outcome at 18–24 h (5 (3;6) versus 3 (3;5), p = .024), 30–36 h (6 (4;8) versus 4 (4;6), p = .033), 42–48 h (7 (5;8.5) versus 4 (4;7), p = .003), 54–60 h (7 (6;9) versus 5 (4;7), p = .003), 66–72 h (8 (6;9) versus 6.5 (4.25;7.75), p = .027) and week one (8 (7;10) versus 6.5 (5;8), p = .021). Additionally, when comparing normal to abnormal outcome, a significant difference was found at week four (12 (9;12) versus 8 (7;10), p = .024). The Burdjalov score was only predictive for a delayed psychomotor outcome, presenting the highest area under the curve (0.690) at week two of life. Conclusion: We observed differences in aEEG signals and neurodevelopmental outcome at the corrected age of 2 years, especially for psychomotor outcome. The predictive value of the Burdjalov score regarding neurodevelopmental outcome at the corrected age of 2 years in preterm infants was low.
Introduction
About 15 million babies are born before 37 weeks gestational age (preterm) worldwide every year. Mortality in preterm infants has been significantly reduced due to progress in obstetrical and neonatal care. However, morbidity is still of great concern, because preterm infants frequently display neurological sequelae including disturbances in cerebral grey and white matter brain development [1]. In long-term preterm infants suffer from psychomotor and cognitive difficulties, which could be improved by identifying infants at high risk and offering special care and extra resources, such as physical therapy, speech and occupational therapy, and different sorts of education services. The evaluation of brain function complements neurological diagnostic methods used to provide important information in order to identify infants at risk and to offer best care to the preterm infant, to advice and to support the parents and caregivers [2]. Associations of amplitudeintegrated electroencephalography (aEEG)-derived parameters with short-term adverse outcome, such as intracerebral haemorrhage or death, have been reported in preterm infants [3].