| Objective : Intracranial hemorrhage(ICH)is a common disease in premature infants,which is closely related to death and long-term neurodevelopmental disorders.ICH is mostly asymptom or non-specific symptoms,so clinical early recognition and evaluation are difficult.In this study,the relationship between blood pressure variability(BPV)and coagulation function indexes and ICH condition and prognosis of premature infants was analyzed.The goal was to investigate whether the combined detection can predict the early onset,severity and prognosis of ICH in premature infants.This provides guidance for early identification,clinical assessment and improvement of prognosis of ICH.Methods : 1.Research object and grouping: Preterm infants admitted to the Affiliated Hospital of Yangzhou University from January 2022 to October 2022 were selected.The occurrence of ICH was screened by brain color ultrasound,and neonatal behavioral neurological assessment(NBNA)and cranial nuclear magnetic resonance imaging(MRI)results reflected the prognosis of ICH infants.They were divided into early preterm infants group and late preterm infants group according to gestational age,ICH group and non-ICH group according to whether there is ICH and good prognosis group and poor prognosis group according to the prognosis.2.Clinical data collection: Basic information and perinatal factors were recorded,including sex,delivery mode,gestational age,birth weight,apgar score,prenatal glucocorticoid,mechanical ventilation,using vasoactive drugs,maternal hypertension during pregnancy,coagulation function,platelets,and blood pressure during the first 3days after admission(measured every 3 hours),etc.The occurrence of ICH was detected by craniocerebral color ultrasound screening on day 1,3 and 7 postnatal days,and the patients with abnormalities were re-examined once a week,while those without abnormalities were re-examined once every 2 weeks.Nuclear magnetic resonance imaging was performed at full term for correcting gestational age,and NBNA examination was performed at 40-42 weeks for correcting gestational age.3.Statistical analysis: Univariate analysis was used to compare the differences of BPV and coagulation function indexes in each group.Multivariate analysis was performed by binary Logistic regression model to evaluate the relationship between each index and the occurrence and prognosis of ICH.The value of each indicator for early prediction and prognosis of ICH was evaluated by receiver operating characteristic curve(ROC curve).Results:1.General information: A total of 86 premature infants were included in this study,including 27 in the early preterm group and 59 in the late preterm group.There were 29 cases in the ICH group and 57 cases in the non ICH group.There were no differences in birth weight and gestational age between the two groups(P>0.05).The proportion of premature rupture of membranes in the ICH group was higher(P<0.05).There were 15 cases in the good prognosis group and 14 cases in the poor prognosis group.There was no statistical significance in the general data between the two groups(P>0.05).2.Coagulation function,BPV indexes,and early prediction of ICH in premature infants: There were statistically significant differences in coagulation function indexes among different gestational age groups(P<0.05).Activated partial thromboplastin time(APTT)and thrombin time(TT)showed a decreasing trend with gestational age increasing,while fibrinogen(FIB)showed an increasing trend.There was statistical significance in BPV indexes of gestational age groups(P<0.05),and the mean blood pressure increased.Coeffcient of variation(CV),variation independent of mean(VIM)of systolic blood pressure(SBP)and VIM of diastolic blood pressure(DBP)decreased with gestational age increasing.Difference between maximum and aminimum(Max-min),standard deviation(SD),CV,VIM of blood pressure and prothrombin time(PT),TT,FIB in ICH group were higher than those in non-ICH group(P<0.05).There was no significant difference in coagulation function indexes among different severity of ICH(P>0.05).Max-min,SD,CV,VIM of SBP and Max-min,CV,VIM of DBP increased with the increase of ICH severity(P<0.05).Binary Logistic regression analysis showed that PT and SBP Max-min were independent risk factors for ICH occurrence.The combined prediction area under curve(AUC)of PT and SBP Max-min was the largest(0.772),and the sensitivity and specificity were 79% and 74% when the Youden index was the largest.3.Coagulation function,BPV indexes,and prognosis of ICH in premature infants:SD,CV,successive variation(SV),VIM of blood pressure and PT,FIB in the group with poor prognosis were higher than those in the group with good prognosis(P<0.05).The parameters meaningful in univariate analysis were substituted into the binary Logistic regression model.PT and SBPSD were independent risk factors for the short-term prognosis of premature infants with ICH.The ROC curve was drawn jointly,and the AUC of the combined prediction probability curve was the maximum.Binary Logistic regression analysis showed that PT and SBP SD were independent risk factors for poor prognosis of ICH preterm infants.The combined prediction AUC of PT and SBP SD was the largest(0.871),and the sensitivity and specificity were 86% and 87%when the Youden index was the largest.Conclusions:1.Coagulation function is positively correlated with gestational age,that is,the older the gestational age,the more mature the coagulation function;2.The blood pressure of preterm infants increases with gestational age,and BPV decreases with gestational age.3.PT and SBP Max-min are independent risk factors for ICH occurrence in premature infants.Combining PT and SBP Max-min can predict the early identification of ICH at a certain extent.4.PT and SBP SD are independent risk factors for the prognosis of premature infants with ICH,and the combination of PT and SBP SD has certain reference value for the short-term prognosis of premature infants with ICH. |
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