振幅整合脑电图联合头颅MRI评估足月新生儿高胆红素血症的价值及神经发育预后的预测价值

The Value of Amplitude-Integrated Electroencephalography Combined with Cranial MRI in Evaluating Full-Term Neonates with Hyperbilirubinemia and Its Predictive Value for Neurodevelopmental Outcomes

摘要: 目的：探究振幅整合脑电图(aEEG)在足月新生儿高胆红素血症临床中的应用价值。方法：本研究选自我院新生儿科2023年12月~2024年11月收治的诊断为新生儿高胆红素血症的足月新生儿为研究对象，分为普通组、重度组，同时取同期医院新生儿科诞生的健康新生儿30例作为对照组，评估早期aEEG各指标对足月新生儿高胆红素血症的预测价值。同时检测患儿入院当天的丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血清总胆红素(TSB)、血清白蛋白(ALB)与血清总胆红素及血清总胆红素与血清白蛋白比值(BAMR)；统计aEEG和MRI的诊断结果；在患儿患病后6个月内进行随访，对患儿进行婴幼儿智能发育量表(CDCC)的评估。结果：重度组患儿ALT、AST、TSB的水平高于普通组患儿的水平(P < 0.05)，对照组新生儿ALT、AST、TSB的水平最低，且在正常范围内；重度组患儿ALB的水平低于普通组患儿的水平(P < 0.05)，对照组新生儿ALB的水平最高，且在正常范围内；重度组患儿BAMR的值高于普通组患儿的值(P < 0.05)，对照组新生儿BAMR的值最低，且在正常范围内。从检测结果来看，aEEG检测下三组患儿的TSB诊断水平更接近标准TSB检测的结果。aEEG检测下的异常率明显高于MRI的检测异常率(P < 0.05)。同时，在患儿6个月龄进行婴幼儿智能发育量表(CDCC)的评估，结果显示，aEEG评估结果与MDI、PDI、CDCC评分成反比相关。结论：振幅整合脑电图联合磁共振成像能够对高胆红素血症足月新生儿的病情和神经发育预后情况进行监测，能够鉴别高胆红素血症的足月新生儿和健康新生儿，相较于常规单一的核磁共振脑电图检查的准确率更高。

Abstract: Objective: To investigate the clinical application value of amplitude-integrated electroencephalography (aEEG) in full-term neonates with hyperbilirubinemia. Methods: This study selected full-term neonates diagnosed with neonatal hyperbilirubinemia who were admitted to the neonatology department of our hospital from December 2023 to November 2024 as the research subjects and divided them into the common group and the severe group. Meanwhile, 30 healthy neonates born in the neonatology department of our hospital during the same period were taken as the control group. To evaluate the predictive value of each indicator of early aEEG for hyperbilirubinemia in full-term neonates. Meanwhile, the alanine aminotransferase (ALT), aspartate aminotransferase (AST), total serum bilirubin (TSB), the ratio of serum albumin (ALB) to total serum bilirubin and the ratio of total serum bilirubin to serum albumin (BAMR) of the children on the day of admission were detected. The diagnostic results of aEEG and MRI were statistically analyzed; Follow-up was conducted within 6 months after the child fell ill, and the infant and toddler intellectual development scale (CDCC) was evaluated for the child. Result: The levels of ALT, AST and TSB in the severe group of children were higher than those in the common group (P < 0.05). The levels of ALT, AST and TSB in the control group of neonates were the lowest and within the normal range. The ALB level of children in the severe group was lower than that of children in the common group (P < 0.05), and the ALB level of neonates in the control group was the highest and within the normal range. The BAMR value of children in the severe group was higher than that of children in the common group (P < 0.05), and the BAMR value of neonates in the control group was the lowest and within the normal range. From the test results, the TSB diagnostic levels of the three groups of children under aEEG detection are closer to the results of the standard TSB test. The abnormal rate detected by aEEG was significantly higher than that detected by MRI (P < 0.05). Meanwhile, the assessment of the infant and toddler intellectual development scale (CDCC) was conducted at the age of 6 months for the children. The results showed that the assessment results of aEEG were inversely proportional to the scores of MDI, PDI and CDCC. Conclusion: Amplitude-integrated electroencephalogram (EEG) combined with magnetic resonance imaging (MRI) can monitor the condition and neurodevelopmental prognosis of full-term neonates with hyperbilirubinemia, and can distinguish between full-term neonates with hyperbilirubinemia and healthy neonates. Compared with the conventional single MRI EEG examination, it has a higher accuracy rate.