基于12月龄神经行为发育结局的无临床症状的足月高危新生儿早期脑电生理筛查的队列研究  

Early electrophysiological screening of high-risk neonates without clinical symptoms based on the prognosis of neurobehavioral follow-up at 12 months of age:A cohort study

作　　者：彭晔 丁颖[1] 杨树梅 岳少杰[1] PENG Ye;DING Ying;YANG Shumei;YUE Shaojie(Department of Neonatology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院新生儿科,长沙410008

出　　处：《中国循证儿科杂志》2023年第2期85-90,共6页Chinese Journal of Evidence Based Pediatrics

摘　　要：背景临床已将脑电监测广泛用于早产儿脑发育评估及脑损伤患儿脑功能评估,无临床症状的足月高危新生儿(简称高危儿)生后早期脑电变化的临床报道较少。目的 探讨高危儿生后早期行脑电筛查的必要性。设计回顾性队列研究。方法 回顾性采集高危儿生后72 h内行脑电生理监测病例的基本信息、孕母信息、产时信息、振幅整合脑电图(aEEG)及视频脑电图(vEEG)信息,以vEEG为脑电监测的金标准,aEEG为筛查手段,基于《发育调查问卷(3)》的语言、大动作、精细动作、解决问题和个人-社会的5个能区,选取《贝利婴儿发展量表》12月龄时的共同类似问题自制神经行为发育筛查问卷,以12月龄时神经行为预后为结局。主要结局指标生后早期脑电监测对12月龄时神经行为预后的筛查效果。结果 符合本文纳入和排除标准的398例高危儿进入本文分析。男205例(51.5%),女193例,胎龄37^(+0)~41^(+2)(38.9±1.1)周,生命体征均平稳,无缺氧表现及神经系统临床表现。均在生后72 h内进行了aEEG和vEEG检查,aEEG真阳性46例,真阴性325例,假阳性0例,假阴性27例,aEEG的敏感度63.0%(95%CI:51.7%~74.4%),特异度100%(95%CI:100%~100%)。vEEG脑电异常组(真阳性46例,假阴性27例)和vEEG脑电正常组(真阴性325例,假阳性0例)高危儿出生体重、小于胎龄儿、住院天数、阴道分娩、产钳助产、宫内窘迫、胎心<100次/分、脐动脉血气pH值、BE值、乳酸差异有统计学意义。386例(97.0%)完成了12月龄时神经行为发育筛查问卷电话随访,vEEG脑电正常组较vEEG脑电异常组(4.1%vs 40.3%)神经行为发育筛查问卷五大能区总分、语言、大动作、精细动作、解决问题和个人-社会能区得分10分比例差异均有统计学意义。结论 以vEEG为金标准,aEEG的敏感度为63.0%,特异度为100%,脑电正常和异常的高危儿分别有4.1%和40.3%于12月龄随访神经行为发育异常,因此生后早�Background Electroencephalogram(EEG)monitoring has been widely used in the assessment of brain development in preterm infants and brain function in children with brain injury.There are few clinical reports on the changes of EEG in high-risk full-term neonates without clinical symptoms in the early stage after birth.Objective To investigate the necessity of early electroencephalogram(EEG)screening in asymptomatic high-risk neonates after birth.Design Retrospective cohort study.Methods The information at birth,maternal information,intrapartum information,discharge diagnosis,aEEG and vEEG results within 72 hours after birth of high-risk infants who underwent electrophysiological monitoring were retrospectively collected.vEEG was used as the gold standard for EEG monitoring,and aEEG was used as the screening method.Based on the five domains of language,gross motor,fine motor,problem solving and personal-social in the Developmental Questionnaire(3),a self-made neurobehavioral development screening questionnaire was made using the common similar questions in the Bayley-Scales of Infant Development at the age of 12 months.The outcome was neurobehavioral prognosis at 12 months of age.Main outcome measures To evaluate the screening effect of early electroencephalogram(EEG)monitoring on neurobehavioral outcomes at 12 months of age.Results A total of 398 high-risk infants who met the inclusion and exclusion criteria were enrolled in this study.There were 205 males(51.5%)and a gestational age of 38.9±1.1(37^(+0)-41^(+2))weeks,all of whom had stable vital signs,no hypoxia or nervous system clinical manifestations.aEEG and vEEG examinations were performed within 72h after birth.With vEEG as the gold standard and aEEG as the screening method,46 cases were true positive,325 cases were true negative,0 case was false positive,and 27 cases were false negative.The sensitivity of aEEG was 63.0%(95%CI:51.7%-74.4%),and the specificity was 100%(95%CI:100%-100%).The vEEG abnormal group included 46 true positive cases and 27 false negati

关 键 词：高危儿 早期脑电监测 神经行为发育随访 

分 类 号：R722.1[医药卫生—儿科]