Cerebral function analysis of neonates with middle to high risk hyperbilirubinemia

doi:10.3877/cma.j.issn.1673-5250.2017.03.018

Objective

To analyze the changes of amplitude integrated electroencephalogram (aEEG) and brainstem auditory evoked potential (BAEP) in brain function evaluation of middle to high risk neonatal hyperbilirubinemia infants.

Methods

From January 2014 to December 2015, a total of 152 infants who diagnosed as high risk neonatal hyperbilirubinemia at Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region were included into this study. They were divided into three groups according to different levels of indirect bilirubin (UCB): group A (serum UCB level≤342 μmol/L, n=32), group B (342 μmol/L<serum UCB level≤427 μmol/L, n=37) and group C (serum UCB level>427 μmol /L, n=83). Both aEEG and BAEP were tested and compared among three groups. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Informed consent was obtained from the parents of each participating patient.

Results

① There was no significant differences among three groups in the aspects of constitution ratio of gender, gestational age and birth weight (P>0.05). ②A total of 152 aEEG records were taken from 152 infants, aEEG was normal in 75 cases (49.3%), abnormal in 77 cases (50.7%). There was significant difference among three groups in aEEG records (χ²=40.874, P<0.05). ③ Among 152 infants, 120 infants finished BAEP test, and BAEP wave Ⅴ showed 90 cases (75.0%) were normal, 30 cases (25.0%) were abnormal. There was significant difference among three groups in BAEP wave Ⅴ (χ²=17.073, P<0.05). ④The aEEG was found to be significantly correlated with abnormal degrees of BAEP wave Ⅴ (r=0.357, P<0.01). ⑤ Among all infants, 33 had acute bilirubin encephalopathy. The occurrence of acute bilirubin encephalopathy was positively correlated with abnormal degrees of BAEP (r=0.549, P<0.01).

Conclusions

The neonates with high risk hyperbilirubinemia should take aEEG and BAEP tests as early as possible, in order to decrease the incidence of neurological sequelae.

Key words: Hyperbilirubinemia, neonatal, Amplitude integrated electroencephalography, Evoked potentials, auditory, brain stem, Infant, newborn

表1 3组中、高危新生儿高胆红素血症患儿基本临床资料比较

组别	例数	性别[例数(%)]		胎龄(周，±s)	出生体重(g，±s)
组别	例数	男	女	胎龄(周，±s)	出生体重(g，±s)
A组	32	18(56.3)	14(43.8)	37.8±1.9	2 994±511
B组	37	26(70.3)	11(29.7)	37.8±1.6	2 942±401
C组	83	64(77.1)	19(22.9)	38.0±1.3	3 115±413
检验值	?	χ²＝4.900		F＝0.165	F＝2.344
P值	?	0.086		0.848	0.099

表1 3组中、高危新生儿高胆红素血症患儿基本临床资料比较

组别	例数	性别[例数(%)]		胎龄(周，±s)	出生体重(g，±s)
组别	例数	男	女	胎龄(周，±s)	出生体重(g，±s)
A组	32	18(56.3)	14(43.8)	37.8±1.9	2 994±511
B组	37	26(70.3)	11(29.7)	37.8±1.6	2 942±401
C组	83	64(77.1)	19(22.9)	38.0±1.3	3 115±413
检验值	?	χ²＝4.900		F＝0.165	F＝2.344
P值	?	0.086		0.848	0.099

表2 3组新生儿高胆红素血症患儿振幅整合脑电图检测结果[例数(%)]

组别	例数	正常	异常
A组	32	28(87.5)	4(12.5)
B组	37	25(67.6)	12(32.4)
C组	83	22(26.5)	61(73.5)
χ²值	?	40.874
P值	?	<0.001

表2 3组新生儿高胆红素血症患儿振幅整合脑电图检测结果[例数(%)]

组别	例数	正常	异常
A组	32	28(87.5)	4(12.5)
B组	37	25(67.6)	12(32.4)
C组	83	22(26.5)	61(73.5)
χ²值	?	40.874
P值	?	<0.001

表3 3组高胆红素血症患儿脑干听觉诱发电位Ⅴ波反应阈结果比较[例数(%)]

组别	例数	正常	异常
A组	27	25(92.6)	2(7.4)
B组	27	24(88.9)	3(11.1)
C组	66	41(62.1)	25(37.9)
χ²值	?	17.073
P值	?	0.001

表3 3组高胆红素血症患儿脑干听觉诱发电位Ⅴ波反应阈结果比较[例数(%)]

组别	例数	正常	异常
A组	27	25(92.6)	2(7.4)
B组	27	24(88.9)	3(11.1)
C组	66	41(62.1)	25(37.9)
χ²值	?	17.073
P值	?	0.001

表4 振幅整合脑电图与脑干听觉诱发电位Ⅴ波反应阈关系

BAEPⅤ波反应阈	aEEG		合计
BAEPⅤ波反应阈	正常	异常	合计
正常	54	36	90
轻度异常	3	6	9
中度异常	2	8	10
重度异常	1	10	11
合计	60	60	120

表4 振幅整合脑电图与脑干听觉诱发电位Ⅴ波反应阈关系

BAEPⅤ波反应阈	aEEG		合计
BAEPⅤ波反应阈	正常	异常	合计
正常	54	36	90
轻度异常	3	6	9
中度异常	2	8	10
重度异常	1	10	11
合计	60	60	120

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