| Objective:To analyze the risk factors related to intraventricular hemorrhage(IVH)in preterm infants with gestational age(GA)< 32 weeks,and explore the effect of hemodynamic influence on the severity of patent ductus arteriosus(hs PDA)and treatment decisions on the occurrence of IVH,providing new ideas for the prevention of IVH.Methods:A retrospective analysis was performed on the clinical data of 1671 premature infants with gestational age < 32 weeks admitted to neonatology department in Shengjing Hospital of China Medical University from January 1,2018 to August 31,2022.The patients without head MRI during hospitalization were excluded.By comparing the clinical data of the two groups,the influencing factors of the occurrence of IVH were preliminarily obtained,and then the Logistic binary regression was used to determine whether the hemodynamic patent ductus arteriosus(hs PDA)was a risk factor for the occurrence of IVH.Performing gestational age stratification to analyze the clinical data of hs PDA group and nhs PDA or n PDA group.After removing the confounding factors of gestational age,the influence of the degree of hs PDA and management decision on the occurrence and severity of IVH was explored.Results:A total of 1418 premature infants(802 males(56.5%)and 616 females(43.4%)were included,with gestation age of 30W+2(24W+4-31W+6)and mean birth weight of1352(498-2680)g.There were 166 patients(11.7%)in IVH group.In the IVH group,the gestation age was 29.7(24.6-31.9)W,the rate of cesarean section was 34.9%(58/166),the rate of prenatal steroid hormones was 30.1%(50/166),the rate of hypertension during pregnancy was 12.0%(20/166),the Apgar score was 7(1-10)/9(4-10)1min/5min,and the p H value of 7.29(7.03-7.52)was significantly lower than that in non-IVH group(p <0.05).The percentage of prenatal infection was 15.1%(25/166),the percentage of endotracheal intubation in the delivery room was 38.6%(64/166),the blood lactate level was 3.2(1.0-12.5)mmol/L and alkali residual-4.8(-20.7-4.2)mmol/L,the invasive ventilation within 1 week was 66.9%(111/166),and the positive inotropic drug 16.9%(28/166),56.6%(94/166)of pulmonary surfactant,57.8%(96/166)of neonatal respiratory distress syndrome,7.8%(13/166)of pulmonary hemorrhage,27.7%(46/166)of PDA27.7%(46/166)and 27.7%(46/166)of hs PDA27.7%(46/166)The rate of discharge or mortality of 3.0%(5/166)was significantly higher than that in the non-IVH group(p < 0.05).The total invasive ventilation time of 3.9(0.0-78.6)days was significantly longer than that of the non-IVH group(p < 0.05).There was no significant difference in nhs PDA ratio between the two groups(p > 0.05).Multivariate Logistic regression analysis showed that prenatal infection(OR:1.831;95%CI:1.069-3.137),hs PDA(OR:2.200;95%CI:1.340-3.614),positive inotropic drugs used within 1 week(OR:1.790;95%CI:1.007--3.182)were risk factors for IVH,cesarean section(OR:0.242;95%CI:0.0.159-0.370),antenatal steroid(OR:0.636;95%CI:0.422-0.958)were protective factors for IVH.Of the 53 hs PDA children in GA < 28 W group,the incidence of IVH in children with mild,moderate and severe clinical classification was 33.3%(7/21),25.0%(5/20),33.3%(4/12),and the incidence of severe IVH was 4.8%(1/21),15.0%(3/20),16.7%(2/12),and there was no statistical difference among them(p > 0.05).There was no significant difference in the incidence of IVH among three hs PDA management strategies:50.0%(6/12),23.1%(3/13),25.0%(7/28)and the incidence of severe IVH: 25.0%(3/12),7.7%(1/13),7.1%(2/28)(p > 0.05).Of the 79 children with hs PDA in 28W≤GA < 30 W group,the incidence of IVH in children with mild,moderate and severe clinical classification was 20.3%(12/59),46.7%(7/15),20.0%(1/5),and the incidence of severe IVH was 3.4%(2/59),20.0%(3/15),0.0%(0/5),and there was no statistical difference among them(p > 0.05).The incidence of IVH in three hs PDA management strategies of conservative therapy,drug therapy alone and surgical therapy was 29.0%(9/31),21.9%(7/32),25.0%(4/16),and the incidence of severe IVH was 9.7%(3/31),0.0%(0/32),12.5%(2/16).There was no statistical difference(p > 0.05).Of the 66 hs PDA children in 30W≤GA < 32 W group,the incidence of IVH in children with mild,moderate and severe clinical classification was 15.5%(9/58),0.0%(0/6),50.0%(1/2),and the incidence of severe IVH was 3.4%(2/58),0.0%(0/6),50.0%(1/2),and there was no statistical difference among them(p > 0.05).There was no significant difference in the incidence of IVH among three hs PDA management strategies:16.2%(6/37),11.1%(2/18),18.2%(2/11)and the incidence of severe IVH: 5.4%(2/37),5.6%(1/18),202%(0/11)(p > 0.05).Conclusion:Patent ductus arteriosus with hemodynamic effects is a risk factor for intraventricular hemorrhage,and the incidence of IVH is higher with smaller gestational age.The higher rate of IVH or severe IVH in larger gestation age groups with hs PDA suggests that the occurrence of IVH is the result of comprehensive factors.Drug or surgical treatment did not increase the incidence of IVH. |
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