| OBJECTIVE:Intracranial hemorrhage is a common clinical problem in neonatal period,severe cases can cause long-term prognosis,and even death.And intracranial hemorrhage,a common complication of preterm infants,is one of the most important reasons of mortality and disability including cerebral palsy and neuro-developmental delay.Intracranial hemorrhage in premature infants according to difference of bleeding site,can be divided into subdural hemorrhage,periventricular-intraventricular hemorrhage,primary subarachnoid hemorrhage,cerebellar hemorrhage.According to the causes of bleeding,it can be divided into traumatic intracranial hemorrhage and hypoxic intracranial hemorrhage.In recent years,with the progress of prenatal care technology,significantly improve the level of Obstetrics,due to traumatic birth injury caused by bleeding decreased year by year,due to hypoxia induced germinal matrix intraventricular hemorrhage has become the main type of intracranial hemorrhage in premature infants.The purpose of this study was to explore the high risk of periventricular intraventricular hemorrhage in premature infants.METHODS:This study collected cranial ultrasonography and clinical data of premature infants who were admitted to NICU of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology during the time between september 1,2014 to september 1,2015.Preterm infants were followed by cranial ultrasound examination on the 3-7 day after birth.The preterm infants were divided into PIVH group and normal group according to cranial ultrasonography.The clinical data of the premature infants such as gestational age,birth weight,amniotic fluid,placenta,umbilical cord,multiple pregnancy,childbirth,prom,asphyxia,mechanical ventilation,hypoglycemia,acidosis,hypercapnia,hypoxemia were compared,analysis of the risk factors of PIVH.All clinical data were input into SSPS 22 software for data processing,and x~2 test,variance analysis and t test were used to analyze the difference of the data.RESULTS:In this study,a total of 319 premature infants were collected,among which there were premature infants with PIVH,the incidence was about 55.4%,and the incidence of severe PIVH(grade III-IV)was about 11.9%(38/319).The incidence rate of PIVH was92.9%in preterm infants below 30 weeks,77.6%in preterm infants below 32 weeks,51.1%in preterm infants below 34 weeks,37.8%in preterm infants below 37 weeks.It showed that the lower gestational age was,the higher incidence rate of PIVH was(x~2=35.5,P<0.05).The incidence rate of PIVH was 90.7%in preterm infants below1500g,59.1%in preterm infants below 2000g,34.3%in preterm infants below 2500g,25%in preterm infants below 4000g.It suggested that the lighter brith weight was,the higher incidence rate of PIVH was(x~2=50.4,P<0.05).In 319 cases,with 64 cases of abnormal maternal amniotic fluid,PIVH group of maternal amniotic fluid have 51 cases and the ratio was 28.8%(51/177),rather than the non PIVH group abnormal pregnant ewe in 13 cases,9.2%(13/142),x~2=19.47,P<0.05.In 319 cases,with 189 cases of maternal pregnancy complications,PIVH group of pregnant women with pregnancy complications in123 cases,the ratio was 69.5%(123/177),and the non PIVH group,maternal pregnancy complications were 66 cases,the ratio was 47.2%(66/142),x~2=16.28,P<0.05.In 319cases,abnormal fetal placenta has 40 cases,have to do with the exception of fetal placenta in PIVH group 24 cases,the ratio was 13.6%(24/177),rather than the non PIVH group,fetal placental abnormalities in 16 cases,ratio of 11.3%(16/142),x~2=0.377,P=0.593.In319 cases,with 17 cases in fetal umbilical cord abnormality,PIVH group of umbilical cord abnormality in 11 cases,the ratio was 6.2%(11/177),and the non PIVH group,fetal umbilical cord abnormality in 6 cases,the ratio was 4.2%(6/142),x~2=0.618,P=0.432.In319 cases of cesarean section in 229 patients,PIVH group with 131 cases of cesarean delivery,the ratio was 74%(131/177),rather than the non PIVH group,cesarean section of98 cases,69%(98/142),x~2=0.971,P=0.324.In 319 cases,there were more than 98 cases of multiple births,and PIVH group of multiple births have 59 cases,with a rate of about33.3%(59/177),while in the non PIVH group,there were more than 39 cases of multiple births with a ratio of(39/142),x~2=1.275,P=0.259.In 319 cases,prenatal premature rupture of membranes in 127 cases,PIVH group before the middle of premature rupture of membranes in 69 cases,the ratio was 39%(69/177),and the non PIVH group,premature rupture of membranes in 58 cases,the ratio was 40.8%(58/142),x~2=0.114,P=0.736.In319 patients,patients with asphyxia in 239 cases,PIVH group had asphyxia in 153 cases,the ratio was 86.4%(153/177),rather than the non PIVH group,asphyxia in 86 cases,the ratio was 60.6%(86/142),x~2=28.08,P<0.05.In 319 cases,245 cases of children with mechanical ventilation,mechanical ventilation of PIVH group had 149 cases,and the ratio was 84.2%(149/177),rather than the non PIVH group,with 96 cases of mechanical ventilation,the ratio was 67.6%(96/142),x~2=12.15,P<0.05.In 319 cases,with 89 cases of hypoglycemia,hypoglycemia in the PIVH group had 63 cases,the ratio was 35.6%(63/177),rather than in the non PIVH group,there were 26 cases of hypoglycemia,the ratio was 18.3%(26/142),x~2=11.7,P<0.05.In 319 cases,84 cases of children with acidosis,acidosis in the PIVH group had 67 cases,the ratio was 37.9%(67/177),rather than the non PIVH group,acidosis in 17 cases,the ratio was 12%(17/142),x~2=27.20,P<0.05.In 319cases of children,with hypercapnia in 107 patients,with hypercapnia in the PIVH group had 76 cases,the ratio was 42.9%(76/177),rather than the non PIVH group,hypercapnia in31 cases,the ratio was 21.8%(31/142),x~2=15.74,P<0.05.In 319 patients,patients with hypoxemia in 103 cases,with hypoxemia in PIVH group had 74 cases,the ratio was 41.8%(74/177),rather than the non PIVH group,hypoxemia in 29 cases,the ratio was 20.4%(29/142),x~2=16.48,P<0.05.Conclusions:In this study,the incidence of PIVH was 55.4%,and the incidence of severe PIVH(grade III-IV)was about 22%in these 319 cases.The risk factors of cerebral hemorrhage in premature infants are more complex,the smaller the gestational age,the lighter birth weight,the higher the incidence of PIHV.Small gestational age and low birth weight are the high risk factors of intracranial hemorrhage in premature infants.The incidence of PIVH was not significantly related to placental abnormality,abnormal umbilical cord,mode of delivery,multiple births,premature rupture of membranes.Small gestational age,low birth weight,abnormal amniotic fluid of pregnant women,maternal complications during pregnancy,asphyxia,mechanical ventilation,hypoglycemia,acidosis,hypercapnia and hypoxemia are the high risk factors for PIVH in preterm infants. |
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