| Objective: This study aimed to analyze the changes in clinical risk factors and MRI features of neonates with hypoxic-ischemic encephalopathy(HIE)after the two-child policy,and help to provide a basis for changes in current perinatal HIE prevention and intervention strategies.Methods: The study enrolled all of the children with HIE(n=328)from January 1st,2016 to December 31 th,2020 at the Third Affiliated Hospital of Zunyi Medical University.Infants with HIE who met the inclusion criteria were divided into the second-born group(SBG)and the first-born group(FBG)according to the number of births.The children were further divided into the second-born preterm group(SBP),second-born full-term group(SBF),firstborn preterm group(FBP),and first-born full-term group(FBF)according to the number of births and gestational age.All children use the Germany Siemens Avanto1.5T MRI scanning system to collect routine brain magnetic resonance imaging and DWI scanning images.Clinical and imaging parameters were compared between groups using nonparametric tests(non-normal distribution)and chi-square tests to retrospectively analyze their clinical risk factors and MRI performance.Results: A total of 328 children with HIE were included,of which 62.8%(206/328)were second-born infants,37.2%(122/328)were first-born infants,67.7%(222/328)were preterm infants and 32.3%(106/328)were term infants;47.3%(155/328)were second-born preterm infants and 15.5%(51//328)were second-born term infants.20.4%(67/328)of first-born preterm infants and 16.8%(55/328)of first-born full-term infants..After the childbearing policy change,the incidence of perinatal risk factors and MRI brain injury patterns in HIE varied by delivery and gestational age.(1)Among the perinatal clinical characteristics of HIE,the differences in gestational age(P=0.004),birth weight(P=0.024),advanced age(P=0.001),scarred uterus(P<0.001),chorioamnionitis(P=0.003),Cesarean section(P<0.001),umbilical cord around the neck(P=0.001)and neonatal asphyxia(P=0.005)between the first-born and second-born groups were statistically significant.In the pattern of brain injury,cortical injury(P=0.818),basal ganglia/thalamic injury(P=0.325),watershed area injury(P=0.982),periventricular white matter injury(P=0.143),posterior limb of the internal capsule(P=0.089),and corpus callosum injury(P=0.995)were not statistically significant between the first-born and first-born groups,and there was a significant difference in intracranial hemorrhage between the two groups(P<0.001),and the incidence of intracranial hemorrhage was higher in infants with HIE in the first-born group than in the second-born group.(2)The incidence of maternal advanced age(P=0.007),scarred uterus(P<0.001),chorioamnionitis(P=0.007),cesarean section(P<0.001),umbilical cord around the neck(P=0.002),amniotic fluid contamination(P=0.002),and placenta praevia(P=0.005)differed between the preterm and full-term groups.In the pattern of brain injury,there were statistically significant differences between preterm and term infants in terms of periventricular white matter injury(P<0.001),watershed area injury(P=0.001),and intracranial hemorrhage(P<0.001).(3)Advanced maternal age is predominantly found in the second-born preterm group.The cesarean section rate was significantly higher in the second-born preterm group than in the first-born preterm and full-term groups(P<0.001),and the incidence of placenta praevia was higher in the second-born preterm group than in the first-born full-term group(P=0.007).The incidence of brain injury in the watershed area was higher in the second-born full-term group than in the second-born preterm group(P=0.001).Scarred uterus(P<0.001)and chorioamnionitis(P=0.007)were significantly more frequent in the second-born preterm and full-term group than in the firstborn preterm and full-term group.The incidence of umbilical cord around the neck(P<0.001)and amniotic fluid contamination(P<0.001)was higher in the first-born full-term group than in the second-born preterm group.Conclusion: The age of HIE pregnant women in the second birth has increased,the incidence of cesarean section,scarred uterus,and placenta previa has increased,the incidence of umbilical cord around the neck and amniotic fluid contamination in the first birth has increased,and the patterns of brain injury in different birth orders have also changed,under the new form of family planning policy,which may result in the changes of the age distribution proportion changed and the change in pregnancy complications,and subsequently caused the changes in the incidence of risk factors and patterns of brain injury of HIE.Active attention should be paid to the perinatal care of pregnant women with different parity,and different preventive and intervention measures should be taken for HIE at different births and gestational weeks. |
PDF Full Text Request