| BacekroundPerinatal hypoxia is an important cause of neonatal morbidity and mortality.EFR(electronic fetal heart rate monitoring)is the most commonly used prenatal fetal monitoring technology in clinical practice.It can detect intrauterine hypoxia early and sensitively.However,because of the poor specificity of EFR for identifying intrauterine conditions and the lack of effective means of early assessment of the risk of brain injury,many neonates are transferred to neonatology department for"pathological" FHR patterns(fetal heart ratedeceleration particularly).However,only a very small number of them developed hypoxic-ischemic encepHalopathy(HIE),most neonates didn,t show any abnormal neurological symptoms and signs during hospitalization.Umbilical arterial blood gas is thought to reflect the intrauterine condition and provide information about the past,present and future of the newborn.Cranial MRI is the best imageological method for diagnosing neonatal brain disease,which can objectively reflect the condition and guide the prognosis.In the past decades,domestic and foreign research mostly focused on neonates with moderate and severe hypoxic ischemic encephalopathy.However,researches on prognostic value of umbilical arterial blood gas analysis of these "healthy" neonates with a history of hypoxia,for neurodevelopmental outcomes,especially long-term outco-mes,is rare and conflicting.Based on this,we designed a prospective study.In the first part of this study,we exploreed the relationship between umbilical arterial blood gas indexes(pH,base excess,lactic acid),NSE,gestational age,birth weight,parity,and delivery mode,et al and short-term outcomes(cranial MRI results at 2-8 days after birth).In the second part,we studied the predictive value of umbilical artery pH,base excess,lactic acid,NSE,etc and long-term neurodevelopmental outcomes(Bayley Ⅱ scoress in four months to six months after birth);In the third part,we further exploreed the relationship between MRI manifestation and long-term neuro develop-mental outcomes of these neonates.Chapter 1 Predictive value of umbilical artery pH,base excess,lactic acid and peripheral blood NSE for cranial MRI results of asymptomatic neonates with prenatal fetal heart rate deceleration 2-8 days after birthObjectiveTo explore the relationship between umbilical artery pH,base excess,lactic acid,peripheral blood NSE and cranial MRI results of asymptomatic neonates with prenatal fetal heart rate deceleration.MethodsInfants born in Nanfang hospital from January 2018 to June 2018,who were admitted to neonatology department because of for fetal heart rate deceleration and show no abnormal neurological symptoms and signs during hospitalization were included in this study.Umbilical arterial blood gas analysis was performed immediately after delivery.Peripheral blood neuron specific enolase(NSE)was measured 6-24 hours after birth.C.ranial MRI was performed 2-8 days after birth(TIWI+T2WI+DWI).MRI results were used as short-term outcomes.ResultsA total of 148 infants were enrolled in this study.Eventrually,140(94.6%)infants underwent cranial MRI.Of them,125(89.3%)had abnormal MRI results and 15(10.7%)had normal MRI results.There is a significant difference in values of umbilical artery BE,lac,and rate of cesarean section between neonates with and without abnormal MRI results(P<0.05).umbilical artery pH values and Apgar scores at 1 min of neonates with abnormal MRI results were lower than those with normal MRI results,but the difference was not statistically significant.Multivarlate analysis showed that lactic acid was a risk factor for abnormal MRI results(OR 1.896,95%CI 1.254～2.867,P=0.002),cesarean section was a protective factor for MRI abnormalities(OR 0.113,95%Cl 0.024～0.541,P=0.006).Further,receiver operating characteristic curve(ROC)was used to detect the value of umbilical artery lactic acid in predicting cranial MRI abnormalities.The area under the curve was 0.781(95%Cl 0.638-0.924,P<0.001).According to the principle of Maximal Yoden index,the optimal cut-off point is 4.75 mmol/L.,of which the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)was 88.0%,66.7%,95.5%and 40.7%,respectively.ConclusionFor neonates with perinatal FHR deceleration,even without clinical neurological symptoms,cranial MRI on 2-8 days after birth showed different degrees of abnor-malities.Umbilical artery lactic acid seems to have a good predictive value for abnormal cranial MRI results.Chapter 2 Predictive value of umbilical artery pH,base excess,lactic acid and peripheral blood NSE for Bayley scores of asymptomatic neonates with prenatal fetal heart rate deceleration at 4-6 monthsObjectiveTo study long-term neurodevelopmental outcomes of tern newborns with perinatal hypoxia but no encephalopathy symptoms,and to study the predictive value of umbilical artery pH,base excess,lactate,peripheral blood NSE for long-term neurodevelopmental outcomes.MethodsInfants bom in Nanfang hospital jfrom January 2018 to June 2018,who were admitted to neonatology department because of perinatal fetal heart rate deceleration and showed no abnormal neurological symptoms and signs during hospitalization were included in this study.Umbilical arterial blood gas analysis was performed immediately after delivery.Peripheral blood neuron specific enolase(NSE)was measured 6-24 hours after birth.Follow-up is made after discharge.Long-term outcomes were based on Bayley scores in 4 months to 6 months after birth.ResultsA total of 148 children were included in the study,Eventrually,134(90.5%)children underwent Bayley Ⅱ test.Of them,116(86.6%)children had normal Bayley scores and 18 children(13.4%)don,t.There is a significant difference in umbilical artery BE values between neonates with abnormal Bayley scores and neonates with normal Bayley scores(-8,59±3.14 vs-6.60±3.00,P=0.010).Multivariate analysis showed that BE(indicated by negative values)was a protective factor of abnormal Bayley scores(OR 0.671,95%Cl 0.483-0.930,P=0.017).Further analysis of the predictive value of BE values for Bayley scores abnormality was made by ROC.Area under the curve was 0.674(95%Cl 0.552-0.795,P=0.018).According to the principle of maximal Yoden index,the optimal cut-off point is-6.05 mmol/L.The sensitivity of predicting Bayley scores abnormality with BE<-6.05mmol/L was 88.9%,specificity was 44.0%,positive predictive value(PPV)was 96.7%,negative predictive value(NPV)was 17.3%.ConclusionLong-term neurodevelopmental outcomes of asymptomatic neonates with prenatal fetal heart rate deceleration are relatively good,of them,only 10%were with abnormal Bayley Ⅱ scores at 4-6 months after birth,and mostly were mild abnormalities.Umbilical artery base excess(BE)may reflect the long-term neurological prognosis of these newborns.Chapter 3 Relationship between cranial MRI manifestation and long-term neurodevelopmental outcomes in asymptomatic neonates with prenatal fetal heart rate decelerationObjectiveTo explore the relationship between cranial MRI manifestation of asymptomatic term neonates with prenatal deceleration and long-term neurodevelopmental outcomes.MethodsInfants bom in Nanfang hospital from January 2018 to June 2018,who were admitted to neonatology department because of perinatal fetal heart rate deceleration and showed no abnormal neurological symptoms and signs during hospitaliza-tion,were included in this study.Umbilical arterial blood gas analysis was performed immediately after delivery.Peripheral blood neuron specific enolase(NSE)was measured 6-24 hours after birth.Cranial MRI was performed 2-8 days after birth(T1+T2+DWI).Follow-up is made after discharge.Long-term outcomes were based on Bayley scores in 4 months to 6 months after birth.ResultsA total of 148 children were enrolled in the study.Eventually,134 patients underwent head MRJ and Bayley Ⅱ test.116 children were with normal Bayley scores and 18 children were with abnormal Bayley scores.MRI main abnormalities and outcomes:1)44(32.8%)cases of white matter swelling,of them,9(20.5%)cases with abnormal Bayley scores 2)Intracranial hemorrhage:64(47.8%)cases of subdural hemorrhage,of them,12(18.8%)cases with abnormal Bayley scores;32(23.9%)cases of subarachnoid hemorrhage,of them,3(9.4%)cases with abnormal Bayley scores;cortical and subcortical white matter hemorrhage in 17(12.7%)cases,4(23.5%)cases were abnormal;2(1.5%)cases of deep white matter hemorrhage,both Bayley scores were normal;11(8.2%)cases of cerebellar hemorrhage,of them,2(18.2%)cases with abnormal Bayley scores;12(9.0%)cases of intraventricular hemorrhage,of them,3(25.0%)cases with abnormal Bayley scores 3)34(25.4%)cases with high signal in cortex and subcortical white matter,of them,7(20.6%)cases with abnormal Bayley scores 4)21(15.7%)cases with high signal in deep white matter(deep frontal lobe,radial crown,paraventricular white matter and lateral ventricle wall),of them,8(38.1%)cases with abnormal Bayley scores 5)15(11.2%)cases of abnormal signals in the basal ganglia,thalamus and internal capsule,of them,3(20.0%)cases with abnormal Bayley scores.Univariate analysis showed that the rate of abnormal Bayley scores was statistically significantly higher in neonates with high DWI signal in deep white matter(frontal white matter,radial crown,paraventricular white matter and lateral ventricle wall).than that in neonates without deep white matter signal abnormalities(P=0.001).There was no statistically significant difference in rates of abnormal scores in children with basal ganglia,thalamic or internal capsule signal abnormalities compared with children without basal ganglia,thalamic or internal capsule signal abnornalities(P≥0.001)..Multivariate analysis showed that cortical and subcortical white matter hemorrhage(OR 4.560,95%Cl 1.108～18.762,P=0.036)and high signal in deep white matter(OR 7.316,95%Cl 2.263～23.649,P=0.001)were risk factors for abnormal Bayley scores.abnormal signals in basal ganglia,thalamic or internal capsule are not predictors of abnormal Bayley scores in 4-6 months.ConclusionThe relationships between MRI findings and long-term nevurodevelopmental outcomes in neonates with prenatal fetal heart rate deceleration but no encephalopathy are different from these of neonates with HIE.DWI high signal in deep white matter and hemorrhage in cortical and subcortical white matter on MRI may be related to long-term neurodevelopmental delay. |
PDF Full Text Request