Study On The Correlation Between The Treatment Of HsPDA And Severe Intraventricular Hemorrhage In Low Birth Weight Infants Evaluated By Ultrasound

Objective:To investigate the correlation between haemodynamically significant patent ductus arteriosus(haemodynamically significant patent ductus arteriosus,hsPDA)treatment and severe Intraventricular hemorrhage(Intraventricular hemorrhage,IVH)in low birth weight infants,and to evaluate the clinical application value of hsPDA treatment in preventing the occurrence and progression of severe IVH in low birth weight infants.Methods:Research Methods: Retrospective analysis was made of the newborns who were admitted to the Neonatal Intensive Care Unit(NICU)of Hubei Maternal and Child Health Hospital within 24 hours after birth from September 2020 to September 2022.330 newborns with birth weight<2500 g were collected.All low birth weight infants were examined by bedside brain ultrasound and bedside echocardiography within 3and 7 days after birth.According to the results of brain ultrasound,they could be divided into 4 levels according to the severity of Paple grading method,Generally,I-II grade is considered as mild IVH,III-IV grade is considered as severe IVH,31 cases of severe IVH are considered as severe group,95 cases of mild IVH and 204 cases without IVH are considered as control group,and 113 cases of low birth weight infants with hsPDA.According to the 47 cases of children treated with oral ibuprofen suspension to promote the closure of hsPDA,they were divided into treatment group and 66 cases treated without oral ibuprofen suspension were not treated group.Statistical processing: SPSS26.0 statistical software was used.General data of enrolled children were analyzed,and univariate analysis was performed.Measurement data with normal distribution were expressed as mean±standard deviation and analyzed by independent sample T-test,while measurement data with non-normal distribution were expressed as median(interquartile distance)and analyzed by Man-whitney U test.Statistical data were compared using chi-square test or fisher’s exact probability method,and logistic regression was used to analyze statistically significant factors.Draw the ROC curve of pregnancy week and birth weight to predict severe IVH and hsPDA treatment and get the cutoff value.Paired sample T-test was used to compare the changes of Vs,Vd and RI in middle cerebral artery before and after oral administration of ibuprofen in the treatment group.The difference of P<0.05 was statistically significant.Results:1.Analysis of related factors of severe IVH in low birth weight infants1.1 The gestational weeks and birth weight of the low birth weight infants with severe IVH were 29.1(27.4,31.4)w and 1140(1050,1530)g,respectively;The gestational weeks,birth weight 34(31.5,35.5)w,and birth weight 1930(1550,2180)g in the non-severe IVH low birth weight infants group were statistically significant(P<0.001);The gestational weeks and birth weight of low birth weight infants with severe IVH were lower than those with non-severe IVH.1.2 To analyze the sex of low birth weight infants in severe IVH group and non severe IVH group,blood oxygen saturation at birth,anemia,NRDS,premature rupture of fetal membrane,Whether the puerpera injected corticosteroids during pregnancy,diabetes during pregnancy,hypertension during pregnancy,mode of delivery,mode of pregnancy,singleton or twins,and 5-minutes Apgar score ≤7,There were significant differences in the situation of invasive tracheal intubation or non-invasive respirator support and hsPDA.5-minutes Apgar score ≤ 7,P value of invasive tracheal intubation respirator support,hsPDA,vaginal delivery,anemia,NRDS were<0.001,<0.001,<0.001,0.006,<0.001,<0.001,<0.001,P<0.05,respectively.1.3 Logistic regression analysis was used to analyze the correlation between the occurrence of severe IVH and the gestational week,birth weight,5-minutes Apgar score ≤ 7,invasive tracheal intubation ventilator support,hsPDA,vaginal delivery,anemia,NRDS.The invasive tracheal intubation respiratory support and hsPDA were the risk factors for the occurrence of severe IVH,with P values of 0.004 and<0.001,respectively.2.The cut-off value of pregnancy week and birth weight to predict severe IVHDraw the pregnancy week and birth weight to predict the severe IVH ROC curve.The cut-off value of pregnancy week is 31.55 w,and the area under the curve is 0.82;The sensitivity is 74.2%,the specificity is 80%,and the Youden index is 0.553;The cut-off value of body weight is 1645 g,and the area under the curve is 0.811;The sensitivity is 70%,the specificity is 88%,and the Youden index is 0.582.3.Comparison of basic data between hsPDA treatment group and untreated group3.1 The gestational weeks of low birth weight infants with hsPDA in the treatment group were 30.50±2.87 w,and the birth weight was 1170(950,1664)g,while the gestational weeks of low birth weight infants with hsPDA in the non-treatment group were 32.79±2.65 w,and the birth weight was 1430(1200,1998)g,P<0.001.The differences were statistically significant.The gestational weeks and birth weight of low birth weight infants with hsPDA in the treatment group were lower than those in the untreated group.3.2 Analyze the difference between the two groups in terms of severe IVH,5-minutes Apgar score≤7,invasive endotracheal intubation or non-invasive mask oxygen respirator support,anemia,premature rupture of fetal membrane,injection of corticosteroids during pregnancy,diabetes in pregnancy,hypertension in pregnancy,general situation,invasive endotracheal intubation ventilator support at 5 minutes of birth The P values of severe IVH were 0.001,0.029 and 0.02 respectively,P<0.05,and the difference was statistically significant.3.3 Logistic regression analysis was used to select the statistically significant factors and analyze the correlation with hsPDA treatment.Among them,gestational age,birth weight,5-minutes Apgar score≤7,severe IVH and hsPDA treatment had a certain correlation(P=0.002,P=0.003,P<0.001,P=0.003),P<0.05 differences were statistically significant.4.The cut-off value of hsPDA treatment predicted by gestational week and birth weightLogistic regression analysis was used to analyze the relevant factors of hsPDA treatment for low birth weight infants,and the ROC curve of pregnancy week and birth weight prediction hsPDA treatment was drawn.The cut-off value of pregnancy week was 31.15 w,and the area under the curve was 0.722;The sensitivity is 74.2%,the specificity is 66%,and the Youden index is 0.402;The cutoff value of body weight is 1280 g,and the area under the curve is 0.714;The sensitivity is 66.7%,the specificity is 74.5%,and the Youden index is 0.412.5.Comparative analysis of MCA blood flow parameters between hsPDA treatment group and untreated group5.1 Comparative analysis of MCA diastolic blood flow loss in the hsPDA treatment group before treatment and in the untreated groupIn the treatment group,4 of the 47 cases of hsPDA low birth weight infants had not closed their DA after two courses of drug treatment.After the clinician performed surgical ligation to close the catheter according to the echocardiogram examination and the overall situation evaluation of the children,the remaining cases were all treated with oral ibuprofen suspension.The first bedside craniocerebral ultrasound examination was performed within 3 days after birth.There were 19 cases(44.18%)of MCA diastole blood flow loss in the treatment group and 5 cases(7.57%)of MCA diastole blood flow loss in the untreated group of hsPDA low birth weight infants.The difference between the two groups was statistically significant(P<0.001).5.2 Comparative analysis of MCA blood flow parameters between the hsPDA treatment group before treatment and the untreated groupThe peak systolic velocity(Vs)of MCA of low birth weight infants with hsPDA in the untreated group was 38.5(27,53.5)cm/s,and the diastolic blood flow velocity(Vd)was 10(6.75,14)cm/s,which was higher than the peak systolic velocity(Vs)28(22,37)cm/s and the diastolic blood flow velocity(Vd)4(0,7)cm/s of MCA before treatment in the treatment group,The blood flow resistance index(RI)of the untreated group was 0.71(0.67,0.77),which was lower than that of the treatment group before treatment,which was 0.84(0.74,1.00),P<0.001.5.3 Comparative analysis of MCA blood flow parameters in hsPDA treatment group before and after treatmentThe blood flow velocity of MCA of low birth weight infants with hsPDA before treatment in the treatment group was low,and the RI value was high.After the treatment with oral ibuprofen to promote the closure of ductus arteriosus,bedside craniocerebral ultrasound and bedside echocardiography were performed after the treatment,and the measured MCA blood flow parameters were(Vs)51(41,63)cm/s,diastolic blood flow velocity(Vd)13(8,17)cm/s,and RI value 0.72(0.68,0.80),The parameters were improved compared with those before treatment,and the difference was statistically significant(P<0.001).6.Closure of catheter during hospitalization in hsPDA low birth weight infants treatment group and untreated groupThe oral administration of ibuprofen suspension in hsPDA low birth weight infants promoted DA closure,of which 47 cases were treated with ibuprofen orally,4cases were still in DA after two courses of drug treatment.Clinicians selected surgical ligation to close DA according to the echocardiogram examination and the overall situation evaluation of the children,and analyzed 66 children in the treatment group and the untreated group who were not treated with surgical ligation.The difference between the two groups in closing rate P=0.703,P>0.05 was not statistically significant.7.Repetitive consistency test resultsRandomly select 30 subjects for echocardiography to display PDA images and MCA blood flow spectrum images on the short axis section of the major arteries.Repeat measurements of PDA width and diameter,with an intra observer correlation coefficient of 0.986(95% CI: 0.971-0.933)and an inter observer intra group correlation coefficient of 0.984(95% CI: 0.966-0.992).Repeatedly measuring the blood flow spectrum parameters Vs,Vd,and RI of MCA,the intra observer correlation coefficients ICC of Vs,Vd,and RI of MCA were 0.905(95% CI:0.811-0.954),0.998(95% CI: 0.996-0.999),and 0.674(95% CI: 0.419-0.830),respectively;The intra group correlation coefficients(ICC)between observers were0.869(95% CI: 0.743 0.935),0.988(95% CI: 0.975 0.994),and 0.849(95% CI: 0.7430.935).Conclusion:1.hsPDA is an important risk factor for the occurrence of severe IVH,so active treatment of hsPDA can effectively prevent the occurrence of severe IVH.2.Oral ibuprofen suspension treatment of hsPDA in low birth weight infants can promote the process of DA closure,help improve brain blood circulation and blood supply,and play a certain role in preventing the occurrence of severe IVH.3.Low birth weight infants need to undergo at least one bedside cranial ultrasound and one bedside echocardiography examination within one week of birth.High risk infants with small gestational age,low weight,and severe clinical symptoms should dynamically monitor their cerebral blood flow and whether there is IVH.Combined with echocardiography,hsPDA should be judged,and the probability of severe IVH should be comprehensively evaluated and predicted.Effective treatment measures should be taken in a timely manner to prevent the occurrence of severe IVH,Improve the quality of life of such children in the later stage.