Effect Of Preeclampsia On Clinical Outcome Of Very Preterm Infants

Objective:In order to improve the prognosis of very preterm infants,we studied the effect of preeclampsia and compared the effects of different types of preeclampsia on very preterm infantsMethods:Very preterm infants(gestational age<32 weeks)delivered in the department of obstetrics of Affiliated Hospital of Qingdao University during from January 1,2019 to March 31,2021 were selected.The selected infants were divided into 2 groups according to whether the mother had preeclampsia or not:chronic hypertension complicated with preeclampsia group and simple preeclampsia group.The control group was defined as very premature infants whose mothers without pregnancy induced hypertension.Collect perinatal clinical data and clinical complications of extremely premature infants,such as broncho pulmonary dysplasia(BPD),early pulmonary hypertension,neonatal respiratory distress syndrome,NRDS),patent ductus arteriosus(hsPDA)with hemodynamic significance,retinopathy of prematurity,ROP),necrotizing enterocolitis,NEC),intracranial hemorrhage,etc.,in order to analyze the influence of preeclampsia on the complications and outcomes of very premature infants during hospitalization.Results1.The gestational age at birth in the chronic hypertension complicated with preeclampsia group and the simple preeclampsia group were(205.8±6.50)days and(204.3±6.65)days respectively,which was significantly lower than that in the control group(212.8±5.96)days(P<0.05).The birth weight of the very preterm infants in chronic hypertension complicated with preeclampsia group and simple preeclampsia group were(1251.2±192.2)g and 1309.6±206.3)g respectively,which were significantly lower than that in the control group(1414.2±219.3)g(P<0.05).The incidence of intrauterine distress in the chronic hypertension complicated with preeclampsia group was not significantly different from that in the simple preeclampsia group,but higher than that in the control group(P<0.05).The incidence of asphyxia in chronic hypertension complicated with preeclampsia group was the highest,and there was significant difference among the three groups(P<0.05).There was no significant difference in small for gestational age(SGA)among the three groups(P>0.05).There was no significant difference in delivery mode among the three groups.2.Family history of hypertension in the chronic hypertension complicated with preeclampsia group was significantly higher than that in the simple preeclampsia group and the control group(P<0.05).There was no difference in the use of antenatal corticosteroid between chronic hypertension complicated with preeclampsia and simple preeclampsia group(P>0.05),but they were higher than those in the control group(P<0.05).3.The incidence of BPD in chronic hypertension complicated with preeclampsia group was 24.2%,which was higher than that in simple preeclampsia group and control group(10.8%and 7.7%respectively),but there was no significant difference among the three groups(P=0.08).The incidence of SGA combined with BPD in chronic hypertension complicated with preeclampsia group and simple preeclampsia group was 87.5%and 75%,which were significantly higher than those in the control group(20.0%).Stepwise logistic regression analysis showed that chronic hypertension complicated with preeclampsia(OR=2.342,95%CI:1.553-3.245),early pulmonary hypertension(OR=1.876,95%CI:1.452-2.856),SGA(OR=1.684,95%CI:1.244-2.356)and the duration of assisted ventilation(OR=1.974,95%CI:1.436-3.025)were the risk factors of BPD in very preterm infants.4.The incidence of NRDS in chronic hypertension complicated with preeclampsia group was 54.6%,there was significant difference among the three groups(P<0.05).The incidence of early pulmonary hypertension and pulmonary hemorrhage in chronic hypertension complicated with preeclampsia group was significantly higher than that in simple preeclampsia group and control group(P<0.05).The incidence of hs PDA(15.2%)was the highest in chronic hypertension complicated with preeclampsia group among the three groups,which was significantly different from that of simple preeclampsia group(2.7%)and control group(0%)(P<0.05).5.The incidence of intracranial hemorrhage and NEC in simple preeclampsia group was significantly higher than that in chronic hypertension complicated with preeclampsia group and control group(P<0.05).There was no significant difference in the incidence of ROP between the chronic hypertension preeclampsia group and the simple preeclampsia group,but they were significantly higher than those in the control group(P<0.05).6.Pulmonary surfactant,duration of assisted ventilation days,time of oxygen therapy days and caffeine in chronic hypertension complicated with preeclampsia were significantly higher than those in simple preeclampsia group and control group(P<0.05).Conclusion:1.The gestational age and birth weight of very preterm infants delivered by preeclampsia mothers were significantly lower than those who delivered by mothers without pregnancy induced hypertension.There incidence of intrauterine distress and birth asphyxia increased.2.The complications of very preterm infants caused by different types of preeclampsia are different.Compared with simple preeclampsia,NRDS,pulmonary hemorrhage,early pulmonary hypertension and hsPDA increased significantly in premature infants caused by chronic hypertension complicated with preeclampsia,and duration of assisted ventilation and oxygen therapy were prolonged.While NEC and intracranial hemorrhage in preterm infants caused by simple preeclampsia group increased.3.Chronic hypertension complicated with preeclampsia,early pulmonary hypertension,SGA and duration of assisted ventilation are the risk factors of BPD.