Early aEEG can Predict Neurodevelopmental Outcomes at 12- To 18- Month of Age in VLBWI with NEC: A Cohort Study

Background: Studies have shown that neurological damage is not uncommon in 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 neonatal necrotizing enterocolitis (NEC). Methods: Infants with NEC (n=13) were selected, and the control group was selected according to 1:1-2 pairing by gestational age. We performed single-channel (P3-P4) aEEG in two groups. The Burdjalov score system was evaluated and compared between the two groups. Cranial magnetic resonance imaging (MRI) was performed at term equivalent age. And the neurological outcomes at 12-18 month of age were compared with Gesell Developmental Schedules (GDS). Results: There was good consistency between the two groups in general conditions, except for the highest C-reactive protein (CRP) and incidence of thrombocytopenia. In the 1 st aEEG examination, the incidence of retardation in Co (7/10:0/16), Cy (8/10:0/16), LB (6/10:0/16), B (8/10:0/16) and Total score(9/10:0/16) were significantly increased in the NEC group (p≤0.01). Cranial MRI in NEC group revealed widened inter-parenchymal space with decreased myelination. The Gesell Developmental Schedules (GDS) assessment indicated that NEC children had inferior performance and lower mean scores in the sub-domains of gross motor (73.12±10.742:94.13±10.366, P<0.001), fine motor (68.15±10.323:100.04±12.608, P<0.001), adaptive behavior (74.79±9.774:100.24±12.175, P<0.001), language (68.59±12.593:96.37±11.493, P<0.001), personal-social responses (82.36±16.013:97.58±11.834, P=0.010) and in overall DQ (73.08±8.901:98.02±9.289, P<0.001). The results of the logistic binary regression analysis revealed that NEC patients had a significantly increased risk of neurodevelopmental retardation compared to no NEC patients (aOR = 27.00, 95% CI 2.561 – 284.696, P = 0.006). Confirmed by Spearman’s rank correlation analysis, the neurodevelopmental outcome was significantly affected by 1 st aEEG Burdjalov score ( r =0.603, p= 0.001). The abnormal 1 st Burdjalov score has predictive value for neurodevelopmental retardation with high specificity (84.62%) and positive predictive value (80.00%). Conclusions: Early aEEG in NEC patients suggested inhibition of brain function. NEC children are more likely developing neurodevelopmental delay. And there’re high specificity and PPV of the early aEEG in predicting neurodevelopmental retardation.