| Objectives: To explore the correlation between early ultrasound cerebral hemodynamics monitoring,neonatal amplitude integrated electroencephalography combined with cranial MRI T1WI/T2 WI ratio measurement and brain injury in premature infants,and the efficacy of appeal index i n predicting the occurrence of brain injury in premature infants and neurological outcome of discharge.Methods: Preterm infants admitted 24 hours after birth to the neonatal unit of Affiliated Hospital of Guilin Medical College from August 1,2020 to December 31,2022 were selected and divided into brain injury group and non-brain injury group(control group).The brain injury group was divided into mild and severe.Clinical data of all subjects were collected,and transcranial ultrasound Doppler cerebral blood flow monitoring,a EEG and cranial MRI were performed.The peak systolic flow velocity(Vs),end-diastolic flow velocity(Vd)and resistance index(RI)of middle cerebral artery were recorded24 hours,72 hours and 1 week after birth.a EEG Burdjalov score at 34 to 40 weeks of gestational age was calculated,and cranial MRI T1 WI,T2WI and T1 WI /T2 WI ratios of different anatomical parts were measured.Neonatal behavioral neurological assessment(NBNA)score was used to determine the neurological outcome at discharge when 37 to 40 weeks of corrected gestational age.The correlation of early cerebral hemodynamics parameters,a EEG Burdjalov score and cranial MRI T1WI/T2 WI ratio with brain injury in preterm infants was analyzed,and the possible risk factors of brain injury in preterm infants were discussed.ROC curve was used to analyze the predictive the occurrence of brain injury in premature infants and neurological outcome at discharge.Results:1.Comparison of clinical data: gestational age,birth weight,duration of invasive mechanical ventilation,duration of oxygen therapy,1min Apgar score≤3,5min Apgar score≤7,SNAPP-Ⅱ score were different between the two groups(P < 0.05),which were influencing factors for brain injury.The incidence of advanced maternal elderly pregnancy,chorioamnionitis or other invasive infections in the brain injury group was higher than that in the non-brain injury group(P<0.05).Brain injury combined with NRDS,sepsis,respiratory failure,and the use of vasoactive drugs,two antibiotics in combination,blood products,and invasive procedures during treatment were higher than those in the control group(P<0.05).2.Multiple Logistic regression indicated that low gestational age and severe SNAPP-Ⅱ score were independent risk factors for brain injury in premature infants.3.(1)Compared with the non-brain injury group,the end diastolic flow velocity of the middle cerebral artery in the brain injury group was decreased at24 hours,72 hours and 1 week,and the resistance index was increased,with the lowest end-diastolic flow velocity at 24 hours.The absolute value of the difference between 24 hours and 72 hours systolic peak velocity was increased(P<0.05).Peak systolic flow velocity decreased at 24 hours and 1 week after birth(P<0.05),but had no significant difference at 72 hours after birth(P<0.05).(2)The a EEG Burdjalov score and the cranial MRI T1WI/T2 WI ratio of frontal lobe and radial crown in the brain injury group were lower than those in the non-brain injury group(P<0.05).4.Compared with mild brain injury,the Severe brain injury middle cerebral artery Vs increased at 72 hours and the absolute value of the difference between24 hours and 72 hours increased(P<0.05).The incidence of a EEG abnormality was increased and Burdjalov score was decreased(P<0.05).5.The end-diastolic flow velocity of middle cerebral artery at 24 hours,72 hours and 1 week was negatively correlated with brain injury of preterm infants,and resistance index was positively correlated with brain injury in premature infants(P<0.05).6.Brain hemodynamics parameters combined with a EEG Burdjalov score and cranial MRI T1WI/T2 WI ratio predicted brain injury in premature infants.The area under ROC curve was 0.949,the Yoden index was 0.765,the sensitivity was 91.9%,and the specificity was 84.6%.When the combined index predicted the abnormal NBNA score at discharge of brain injury in premature infants,the area under ROC curve was 0.893,the Yoden index was 0.661,the sensitivity was 91.3%,and the specificity was 74.8%.Conclusions:1.Low gestational age and severe SNAPP-Ⅱ score are independent risk factors for brain injury in premature infants.2.The end diastolic flow rate of the middle cerebral artery of preterm infants decreased 24 hours after birth,and the resistance index increased,suggesting that the possibility of brain injury is higher in preterm infants.Peak systolic flow velocity of middle cerebral artery changed significantly within 72 hours after birth,suggesting that the degree of brain injury in premature infants may be more serious.Cerebral hemodynamics combined with a EEG Burdjalov score and cranial MRI T1WI/T2 WI ratio,it has certain reference value for predicting brain injury in premature infants and abnormal NBNA score at discharge. |
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