Clinical Study On The Evaluation Of Neurodevelopmental Prognosis In Premature By Color Doppler Ultrasonography

ObjectiveInvestigate the clinical significance between intracranial parameters and neurodevelopmental prognosis of premature fetus period and after birth by color Doppler ultrasonographyMethods1.Clinical data:A total of 3356 preterm infants born in Wuxi Maternal and Child Health Hospital from January 2017 to June 2018 were included retrospectively and statistically,among which 174 preterm infants met the inclusion and exclusion criteria(94 male and 80 female).According to gestational age at birth,they were divided into 32～34 W and 35～36 W groups.Each group was divided into poor prognosis and good prognosis according to the neuropsychological development assessment results of children aged 0～6 years at 6 month after birth.The prognosis was poor if the developmental quotient was below 85,and good if the developmental quotient was above 85.The 32～34W group included 91 cases(50 male and 41 female),mean(33.08±0.83W).There were 68 cases with poor prognosis and 23 cases with good prognosis.The 35～36W group included 83 cases(44 male and 39 female),mean(35.87±0.55W).There were 34 cases with poor prognosis and 49 cases with good prognosis.Inclusion criteria:(1)Premature infants with gestational age of 32～36W;(2)Weight:1500～2500 grams;(3)Complete ultrasonography data;(4)Regular follow-up after birth;(5)Preterm infants with neuropsychological development in children aged 0 to 6 years at 6 month after birth.Exclusion criteria:Patients with congenital diseases affecting brain development(such as dysgenesis of the corpus callosum,cerebral vascular malformation,congenital heart disease,thalassemia,etc.).2.Inspection method:2.1 When premature infants in 24～27W during fetal period,through the pregnant woman’s abdomen the lengh of corpus callosum(CC-L)were measured on the median sagittal section of fetal head by two-dimensional ultrasonography.Color Doppler flow imaging(CDFI)was used to test and record the hemodynamic parameters of middle cerebral artery(MC A):peak systole velocity(PS V)、end diastolic flow velocity(EDV)、pulsatility index(PI)、resistance index(RI)and systolic peak flow velocity/end diastolic flow velocity(S/D).It is performed by a physician with more than 8 years of experience in obstetric ultrasound.2.2 Acrossing the anterior fontanelle CC-L was measured by central sagittal view of the brain with two-dimensional ultrasonography at 3 days and 6 weeks after birth.The growth rate of CC was calculated from 0 to 6 weeks.Acrossing the temporal window CDFI was used to test and record the hemodynamic parameters of MCA:PSV、EDV、PI、RI and S/D.It was completed by a physician with more than 8 years of experience in craniocerebral ultrasound.2.3 Postnatal follow-up of preterm infants:All subjects were assessed at 6 months after birth with the Neuropsychological Development Scale for Children aged 0～6 years.3.Statistical method:SPSS 23.0 software was used for data processing and analysis.The measurement data is expressed in(x±s).The t test was used for comparison between the two groups.The use case number of counting data indicates that chi-square test is used for comparison between the two groups.The hemodynamic parameters of MCA were used to evaluate the prognosis of preterm infants,respectively were used to judge the prognosis of premature infants.The 2 × 2 cross contingency table was used for the contingency coefficient.The relationship between the length of corpus callosum within 3 days and 6 weeks after birth、the growth rate of corpus callosum and gestational age at birth were analyzed by linear correlation analysis and r value was calculated.Results1.Intracranial parameters of preterm infants during fetal period1.1 Fetal CC-L32～34W Group:CC-L in preterm infants with poor prognosis and those with good prognosis were 31.00±1.84mm vs.31.35±1.67mm.35～36W Group:CC-L in preterm infants with poor prognosis and those with good prognosis 31.29±1.62mm vs.30.71±1.72mm.There were all no significant difference between two group(p>0.05).1.2 Hemodynamic parameters of fetal MCA32～34W Group:PSV in preterm infants with poor prognosis and those with good prognosis were 31.72±3.48cm/s vs.29.58±3.08cm/s;EDV were 7.29±2.08cm/s vs.5.90±1.56 cm/s;PI were 1.58±0.33 vs.1.78±0.25;RI were 0.75±0.08 vs.0.79±0.07;S/D were 4.65±1.28 vs.5.28±1.23.35～36W Group:PSV in preterm infants with poor prognosis and those with good prognosis were 32.43±2.76cm/s vs.32.43±2.76cm/s;EDV were 7.14± 1.86cm/s vs.6.01 ± 1.51cm/s;PI were 1.63±0.32 vs.1.78±0.27;RI were 0.76±0.09 vs.0.81 ±0.06;S/D were 4.82±1.18 vs.5.37±1.19.PSV and EDV of different gestational age preterm infants in the poor prognosis group was higher than that in the group with good prognosis,while S/D、PI and RI group were all lower than those in the group with good prognosis.The difference was significant(p<0.05).1.3The correlation analysis between the hemodynamic parameters of MCA and prognosisPSV、EDV、PI、RI、S/D were all correlated with prognosis(the contingency coefficient was 0.29、0.30、0.30、0.17、0.20 respectively),among which EDV and PI were the most closely related to prognosis。2.Intracranial parameters of preterm infants after birth2.1 Premature CC-L32～34W Group:CC-L in preterm infants with poor prognosis and those with good prognosis within 3 days after birth were 38.13± 1.19mm vs.38.21 ±0.90mm;CC-L within 6 weeks after birth were 43.38± 1.62mm vs.45.91 ± 1.37mm;the growth rate of CC from 0 to 6 weeks after birth were 0.87±0.16mm/W vs.1.27±0.20mm/W;35～36W Group:CC-L in preterm infants with poor prognosis and those with good prognosis within 3 days after birth were 41.47±1.26mm vs.41.3±1.16mm;CC-L within 6 weeks after birth were 46.88±1.62mm vs.48.91±1.69mm;the growth rate of CC from 0 to 6 weeks after birth were 0.89±0.20mm/W vs.1.25±0.21mm/W.CC-L within 3 days after birth is not associated with prognosis in preterm infants CC-L within 6 weeks and the growth rate of CC from 0 to 6 weeks after birth in poor prognosis group were lower than that in good prognosis group(p<0.05).There was a positive correlation between CC-Land gestational age within 3 days and 6 weeks.However,there was no correlation between the growth rate of CC from 0 to 6 weeks.In poor and good prognosis preterm infants the correlation coefficient r between CC-L and gestational age at birth were 0.88 vs.0.86 within 3 days after birth,those within 6 weeks after birth were 0.77 vs.0.81.The correlation coefficient r between the growth rate of CC from 0 to 6 weeks after birth and gestational age were 0.00 vs.0.11.2.2 Hemodynamic parameters of MCA within 3 days after birth.32～34W Group:PSV in preterm infants with poor prognosis and those with good prognosis were 39.94±8.37cm/s vs.45.95±10.29cm/s;EDV were 9.16±3.77 cm/s vs.12.78±3.54 cm/s;PI were 1.62±0.32 vs.1.43±0.21;RI were 0.76±0.08 vs.0.72±0.05;S/D were 5.26±2.99 vs.3.85±0.92.35～36W Group:PSV in preterm infants with poor prognosis and those with good prognosis were 41.59±8.10cm/s vs.45.73±8.38cm/s;EDV were 9.56±3.45cm/s vs.13.14±3.87cm/s;PI were 1.59±0.27 vs.1.29±0.24;RI were 0.76±0.06 vs.0.69±0.07;S/D were 4.95±2.00 vs.3.73±1.13.PSV and EDV of poor prognosis premature infants in two gestational age groups were lower than those in good prognosis group;PI、RI and S/D were higher than those in good prognosis group.There were differences between the two groups(p<0.05).2.3 The hemodynamic parameters of MCA in preterm infants at 6 weeks after birth32～34W Group:PSV in preterm infants with poor prognosis and those with good prognosis were 63.50±15.08cm/s vs.69.34±12.57cm/s;EDV were 18.88±5.74cm/s vs.21.95±8.11cm/s;PI were 1.31±0.23 vs.1.26±0.16;RI were 0.72±0.06 vs.0.72±0.03;S/D were 3.53±1.04 vs.3.37±0.71.35～36W Group:PSV in preterm infants with poor prognosis and those with good prognosis were 66.82±8.91cm/s vs.68.61 ± 11.14cm/s;EDV were 19.53±4.04cm/s vs.20.45±5.18cm/s;PI were 1.27±0.18 vs.1.20±0.19;RI were 0.72±0.04 vs.0.70±0.05;S/D were 3.51 ±0.62 vs.3.51±0.74.There was no correlation between the hemodynamic parameters and the prognosis of premature infants after 6 weeks of age(p>0.05).2.4 The correlation analysis between the hemodynamic parameters of MCA and prognosis within 3 days after birthPSV、EDV、RI were all correlated with prognosis at 3 days after birth(the contingency coefficient was 0.28、0.29、0.24 respectively),among which EDV was the most closely related to prognosis.3.Sensitivity and specificityIn the fetal period PSV and EDV were higher than the normal two standard deviations、PI<1.6、S/D<4.0、RI<0.6,were considered as abnormal hemodynamic parameters,and the premature infants was predicted.The sensitivity was 28.43%、31.37%、33.33%、9.81%、35.29%.The specificity was 95.83%、94.44%、77.78%、98.60%、83.33%.At 3 days after birth RI≤0.50 or RI≥0.75,PSV and EDV was higher and lower than 2D were considered as abnormal hemodynamic parameters,and the premature infants was predicted.The sensitivity was 26.47%、32.35%、52.94%.The specificity was 95.83%、93.06%、72.22%.Conclusion1.The hemodynamic parameters of middle cerebral artery in preterm infants during the fetal period and within 3 days after birth are related to the prognosis.Increased blood flow velocity,decreased resistance index and pulse index of middle cerebral artery in preterm infants often indicate intrauterine hypoxia.Decrease in blood flow velocity and increase in pulse index and resistance index within 3 days after birth often indicate the possibility of cerebral hypoxia.2.The growth rate of corpus callosum at 6 weeks and 0～6 weeks after birth is related to prognosis.The corpus callosum grows slowly in patients with poor prognosis.The length and diameter of corpus callosum were positively correlated with gestational age within 3 days and 6 weeks.