| Cerebral injury is the common nervous system disease of preterm infants, whichhave many kinds of types. Peri-intraventricular hemorrhage(PIVH) andperiventricular white matter injury(PWMI) are the most common types of cerebralinjury of preterm infants. Currently the researches on PIVH and PWMI are mainlylimited to pathogenesis, diagnosis,treatment and prognosis. The researches of PIVHand PWMI on the voiding pattern of preterm infants are rare.Voiding is an complicated nervous reflex, which need the jointly participation ofthe junior micturation central located in the lumbosacral portion of spinal cord andthe senior micturation central above the spinal cord. The senior micturation centralabove the spinal cord mainly include the urine retention central and the micturationcentral located in the pons, the gray matter around the midbrain pipe, thalamus andsome areas of the cerebral cortex and there are extensive connections of nerve fibers.Cerebral functional imaging found the actions of these mentioned areas weresignificantly enhanced in the adult micturation process, indicating senior nervecentral coordinate the whole micturation reflex of adult. The effect of cerebral injuryon the adult micturation is significant. The cerebral diseases such as cerebral infarction and cerebral hemorrhage always induce the change of adult micturationpattern accompanied with the appearance of frequent micturation and urgent urination.The adult patients with periventricular white matter injury always have obviousbladder dysfunction which indicate periventricular white matter injury plays animportant role in the micturation reflex.The newborn micturation traits mainly include frequent voiding, low voidedamount,post-void residual urine, interrupted voiding and so on. The free voidingobservation found when voiding the full term infants were accompanied with obviousawakening signs such as awakening from sleep and body movement.Electroencephalogram found the change of brain waves in the voiding process of fullterm infants, indicating cerebral cortex has been participated in the voiding reflex offull term infants. The free voiding observation found only some voids of preterminfants were accompanied with awakening signs, most voids happened in the sleep.Electroencephalogram found no change of brain waves in the voiding process ofpreterm infants. These foundings indicate the voidings of preterm infants areimmature than the voidings of full term infants. The role of senior nervous center inthe voiding reflex of preterm infants need to be discussed.PIVH of preterm infants is located in the head of caudatum outside theparaceles,which near some senior micturation centers such as thalamus,periventricular white matter. PIVH could affect these senior micturation centersthrough many ways. Slight PIVH is not accompanied with the ventricle expansionand serious PIVH is accompanied with the ventricle expansion. The preterm infantswith serious PIVH were not adopted in this research because of the critical condition.PWMI could be divided into slight PWMI and serious PWMI according to theduration of periventricular strong echoes. The duration of periventricular strongechoes of slight PWMI is less than7days and the duration of serious PWMI is more than14days. The research of serious PWMI on the voiding pattern of preterm infantscould effectively reflect the role of senior nervous center in the voiding reflex ofpreterm infants.In this research the preterm infants with slight PIVH, the ones with seriousPWMI and the healthy ones were observed free voiding for8hours and many typesof voiding parameters were collected. The voiding patterns of these infants werecompared and it is found that cerebral injury had an obvious effect on the voidingpattern of preterm infants indicating senior nervous center has participated in thevoiding reflex of preterm infants with older gestational age.Objective:To evaluate the effect of slight peri-intraventricular hemorrhage(PIVH) andserious periventricular white matter injury(PWMI) on the voiding pattern of preterminfants.Methods:This research included55preterm infants (gestational age:32-35weeks) whowere examined by cerebral ultrasound in the first week after birth. According to thecerebral status these infants were divided into the slight PIVH group, the seriousPWMI group and the normal group. The slight PIVH group included20preterminfants.The serious PWMI group included19ones. The normal group included16ones. The8-hours free voiding observation were performed to the preterm infantswith slight PIVH, the ones with serious PWMI and the healthy ones in their postnatalage of9-15days. The voiding times, every voided volume, post-void residual volume,the awakening voiding and the interrupted voiding about every infant were recorded in the observation process. The voiding parameters between the infants with slightPIVH and the healthy ones were compared through statistical software.The voidingparameters between the infants with serious and the healthy ones were also comparedthrough statistical software.Results:The empty voiding percentage((26±11)%vs.(34±7)%,P=0.02) and awakeningvoiding percentage((34±11)%vs.(42±7)%,P=0.01) of preterm infants with slightPIVH were significantly lower than the healthy ones, the post-void residual volume((P25=0ml., P50=2ml., P75=3ml.)vs.(P25=0ml., P50=2ml., P75=2ml.), P=0.02) wassignificantly more than the healthy ones. There were no significant differences ofvoiding times(（6.6±1.1）vs.(7.0±1.1),P=0.29),every voided volume((16.4±5.4)ml.vs.(15.9±5.3)ml., P=0.43) and interrupted voiding percentage (50%vs.44%, P=0.75)between the slight PIVH group and normal groups.The voiding frequency((5.1±1.0)vs.(7.0±1.1), P<0.01), awakening voidingpercentage （(23±11)%vs.(42±7)%, P<0.01) and empty voiding percentage((P25=16%, P50=20%,P75=28%) vs.(P25=28%, P50=33%, P75=40%), P<0.01)weresignificantly lower, while the voided volume(19.9±6.6)ml.vs.(15.9±5.3)ml.,P<0.01）and post-void residual volume(（P25=1ml.,P50=3ml.,P75=3ml.） vs.(P25=0ml.,P50=2ml.,P75=2ml.),P<0.01) were significantly higher in the preterm infants withserious PWMI, compared to the healthy infants (P <0.05). There was no significantdifferences of interrupted voiding percentage(52%vs.44%, P=0.74) between theserious PWMI group and normal group. Conclusion:1. There is an significant effect of slight PIVH on the voiding consciousness andbladder empty of preterm infants with gestational older ages.2. Serious PWMI has a significant effect on the whole voiding pattern of preterminfants with older gestational age with the significantly decreased voiding times andthe significantly increased voided volume.3.Senior nervous center has participated in the voiding reflex of preterm infantswith older gestational age.4.The senior nerve centre above brain stem plays a facilited role in the voidingreflex of preterm infants older gestational age. |
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