Clinical Analysis Of Hypothermic Treatment Of Neonatal Hypoxic-ischemic Encephalopathy

Objective The essence of asphyxia is hypoxia,which can threaten the life of the newborn and cause functional impairment of multiple organs,especially the central nervous system,resulting in ischemic hypoxic brain injury of the newborn,leaving neurological sequelae,causing a burden on the family and society.In recent years,with the rapid development of perinatal technology and neonatal treatment technology,HIE is still one of the important causes of neonatal death,mental retardation,cerebral palsy,epilepsy and other neurological damage in infants.Hypoxic Ischemic Encephalopathy(HIE)in infants Meta-analysis so far shows that mild hypothermia treatment can significantly reduce HIE mortality,improve the long-term prognosis of children from 6 months to 7 years(the incidence of severe neurological defects and cerebral palsy is significantly reduced),and reduce the incidence of severe neurological development disorders.Sinus bradycardia and thrombocytopenia were associated with mild hypothermia.However,other adverse reactions such as severe hypotension,increased infection,electrolyte and coagulation dysfunction,acid-base imbalance,blood glucose metabolism disorder,pulmonary hemorrhage and other mild hypothermia treatment had no significant effect within 72 hours.At present,the safety and effectiveness of mild hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy is still controversial,and there are still reports of individual cases of multiple organ system dysfunction during mild hypothermia treatment.Whether the multiple organ system dysfunction is caused by mild hypothermia treatment or the development of neonatal asphyxia itself,there are no multiple research centers on multiple organ damage of neonatal asphyxia at home and abroad,let alone recognized diagnostic criteria.The second Maternity and Child Health Hospital of Huizhou has been treating mild hypothermia since 2014,so far the curative effect is satisfactory,and no obvious adverse reactions have occurred.Therefore,based on domestic and foreign studies,combined with our clinical study,it is necessary to summarize and analyze the effects of mild hypothermia on the important organ functions of HIE neonates,and conduct a preliminary discussion on the homeostasis and safety of internal environment,so as to provide clinical basis for the treatment of mild hypothermia for advanced premature HIE.It provides the research foundation for the next multi-center research,and makes our hospital become the regional treatment center of neonatal mild hypothermia.MethodsA retrospective analysis was performed on 80 children admitted to the department of Neonatology of our hospital who were diagnosed with neonatal hypoxic ischemic encephalopathy from July 1st,2014 to July 1st,2020-july 1st,2014 and underwent72-hour mild hypothermia therapy as the observation group.During the same period,Huizhou Boluo People’s Hospital and Foshan Chancheng Central Hospital(both hospitals of the same level did not carry out mild hypothermia treatment.A total of 50 children who were diagnosed with neonatal hypoxic-ischemic encephalopathy and met the need for mild hypothermia but were not treated as a control group were able to provide routine treatment according to guidelines issued in 2011.The observation group was treated with mild hypothermia,the control group was not treated with mild hypothermia,and the rest of the treatment followed conventional treatment.The gestational age,birth weight,Apgar score and neurobehavioral status of the three groups were compared.Then compared to the low temperature before and after treatment group and control group in ALT,AST,CK-MB,creatinine,urea nitrogen,glucose,potassium,sodium,calcium and blood gas(p H),the differences between the indices such as vital signs,to analyze the treatment of neonatal hypoxic ischemic encephalopathy important viscera function at low temperature influence and stable internal environment and related clinical data differences.Statistical software SPSS22.0 was used for statistical analysis and relevant conclusions were drawn.Results1.In the observation group,there were 50 males and 30 females.In the control group,there were 38 males and 12 females.There was no statistical difference in gender between the two groups.There were no significant differences in gestational age and birth weight between the observation group and the control group.There was no statistical difference in HIE component between the two groups.There was no statistical difference in Apgar score at 1 and 5 minutes between the two groups.2.There were no statistical differences in ALT,CK-MB,creatinine and urea nitrogen between the two groups before mild hypothermia treatment.There were no significant differences in ALT,CK-MB,creatinine and urea nitrogen between the observation group and the control group after 72 hours of treatment.3.There were no statistical differences between the observation group and the control group in the blood glucose,potassium ion,sodium ion,calcium ion and blood gas(PH)at24h,48 h and 72 h before and during the mild hypothermia treatment.4.There was no statistical difference in PLT,PT and APTT between the observation group and the control group at 24 h,48h and 72 h before and during mild hypothermia treatment.5.Before mild hypothermia treatment,there was no difference in body temperature,heart rate,respiration,systolic blood pressure and diastolic blood pressure between the two groups.During the mild hypothermia treatment,the differences in body temperature,heart rate and respiration between the observation group and the control group were statistically significant.However,there was no statistical difference in systolic and diastolic blood pressure among the three groups.Conclusions1.Through the analysis of relevant data of vital signs,it is proved that mild hypothermia can reduce respiration and heart rate,and has no obvious influence on blood pressure.2.Through the analysis of liver,renal function and myocardial enzyme related data,it was proved that mild hypothermia had no significant effect on myocardial function,liver and kidney function.3.Through the analysis of data related to electrolyte,blood glucose and blood gas PH,it is proved that mild hypothermia has no significant influence on blood gas PH,electrolyte and glucose metabolism.4.Through the data analysis of platelet and coagulation function,it was proved that PT and APTT had no significant influence on platelet and coagulation function during mild hypothermia.