Department of Neonatology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 West Xueyuan Road, Wenzhou, 325027, Zhejiang, China.
Children's Rehabilitation Department, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
BMC Pediatr. 2021 Dec 20;21(1):582. doi: 10.1186/s12887-021-03056-6.
Studies have shown that neurological damage is common in necrotizing enterocolitis (NEC) survivors. The purpose of the study was to investigate the predictive value of amplitude-integrated electroencephalogram (aEEG) for neurodevelopmental outcomes in preterm infants with NEC.
Infants with NEC were selected, and the control group was selected based on 1:1-2 pairing by gestational age. We performed single-channel (P3-P4) aEEG in the two groups. The Burdjalov scores were compared between the two groups. Cranial magnetic resonance imaging (MRI) was performed several months after birth. The neurological outcomes at 12 to 18 months of age were compared with the Gesell Developmental Schedules (GDS). The predictive value of aEEG scores for neurodevelopmental delay was calculated.
There was good consistency between the two groups regarding general conditions. In the 1st aEEG examination, the patients in NEC group had lower Co (1.0 (0.0, 2.0) vs. 2.0 (2.0, 2.0), P = 0.001), Cy (1.0 (0.0, 2.0) vs. 3.0 (3.0, 4.0), P < 0.001), LB (1.0 (0.0, 2.0) vs. 2.0 (2.0, 2.0), P < 0.001), B (1.0 (1.0, 2.0) vs. 3.0 (3.0, 3.5), P < 0.001) and T (3.0 (2.0, 8.0) vs. 10.0 (10.0, 11.5), P < 0.001), than the control group. Cranial MRI in NEC group revealed a widened interparenchymal space with decreased myelination. The abnormality rate of cranial MRI in the NEC group was higher than that in the control group (P = 0.001). The GDS assessment indicated that NEC children had inferior performance and lower mean scores than the control group in the subdomains of gross motor (71 (SD = 6.41) vs. 92 (SD = 11.37), P < 0.001), fine motor (67 (SD = 9.34) vs. 96 (SD = 13.69), adaptive behavior (76 (SD = 9.85) vs. 95 (SD = 14.38), P = 0.001), language (68 (SD = 12.65) vs. 95 (SD = 11.41), P < 0.001), personal-social responses (80 (SD = 15.15) vs. 93(SD = 14.75), P = 0.037) and in overall DQ (72 (SD = 8.66) vs. 95 (SD = 11.07), P < 0.001). The logistic binary regression analysis revealed that the NEC patients had a significantly greater risk of neurodevelopmental delay than the control group (aOR = 27.00, 95% CI = 2.561-284.696, P = 0.006). Confirmed by Spearman's rank correlation analysis, neurodevelopmental outcomes were significantly predicted by the 1st aEEG Burdjalov score (r = 0.603, P = 0.001). An abnormal 1st Burdjalov score has predictive value for neurodevelopmental delay with high specificity (84.62%) and positive predictive value (80.00%).
Children with NEC are more likely to develop neurodevelopmental delay. There is high specificity and PPV of early aEEG in predicting neurodevelopmental delay.
研究表明，坏死性小肠结肠炎（NEC）幸存者常有神经损伤。本研究旨在探讨振幅整合脑电图（aEEG）对 NEC 早产儿神经发育结局的预测价值。
选择 NEC 患儿，按 1：1-2 配对选择胎龄相匹配的对照组。对两组进行单通道（P3-P4）aEEG 检查。比较两组 Burdjalov 评分。出生后数月行头颅磁共振成像（MRI）检查。12-18 月龄时采用 Gesell 发育量表（GDS）进行神经发育评估。计算 aEEG 评分预测神经发育迟缓的价值。
两组患儿一般情况具有良好一致性。在首次 aEEG 检查中，NEC 组患儿的 Co（1.0（0.0，2.0）比 2.0（2.0，2.0），P=0.001）、Cy（1.0（0.0，2.0）比 3.0（3.0，4.0），P<0.001）、LB（1.0（0.0，2.0）比 2.0（2.0，2.0），P<0.001）、B（1.0（1.0，2.0）比 3.0（3.0，3.5），P<0.001）和 T（3.0（2.0，8.0）比 10.0（10.0，11.5），P<0.001）值均较低。NEC 组患儿头颅 MRI 显示脑实质间隙增宽伴髓鞘化减少。NEC 组头颅 MRI 异常率高于对照组（P=0.001）。GDS 评估显示，NEC 患儿在粗大运动（71（SD=6.41）比 92（SD=11.37），P<0.001）、精细运动（67（SD=9.34）比 96（SD=13.69），P<0.001）、适应行为（76（SD=9.85）比 95（SD=14.38），P=0.001）、语言（68（SD=12.65）比 95（SD=11.41），P<0.001）、个人-社会反应（80（SD=15.15）比 93（SD=14.75），P=0.037）和总体发育商（DQ）（72（SD=8.66）比 95（SD=11.07），P<0.001）等各亚领域的表现均低于对照组。二元逻辑回归分析显示，NEC 患儿发生神经发育迟缓的风险明显高于对照组（aOR=27.00，95%CI=2.561-284.696，P=0.006）。Spearman 秩相关分析证实，神经发育结局与首次 aEEG Burdjalov 评分显著相关（r=0.603，P=0.001）。首次 Burdjalov 评分异常对神经发育迟缓有较高的预测价值，具有较高的特异性（84.62%）和阳性预测值（80.00%）。
NEC 患儿更易发生神经发育迟缓。早期 aEEG 对预测神经发育迟缓有较高的特异性和阳性预测值。
