The Clinical Study On Risk Factors Of Intracranial Hemorrhage Of The Premature Infants

Intracranial hemorrhage is mainly a lesion of the neonatal brain, especially the premature brain.The mortality rate of intracranial hemorrhage is high,and the survivors with severe intracranial hemorrhage have much higher incidence of neurologic sequelae.There are six major clinically important categories of intracranial hemorrhage: Periventri cular-intrav entricular hemorrhage,subarachnoid hemorrhage, intracerebral hemorrhage,subdural hemorrhage,intracerebellar hemorrhage and mixed intracranial hemorrhage. The pathogenetic factors of intracranial hemorrhage include hypoxia and birth trauma.In recent years,following the improvement of obstetrics technique and the development of neonate intensive care,intracranial hemorrhage of newborn takes place two obvious changes:One is subdural hemorrhage relating to trauma is obviously reducing, and intracranial hemorrhage takes place mainly in the premature infants and the neonate with perinatal risk factors;the other is conspicuous rising of the survival rate with intracranial hemorrhage. Periventricular-intraventricular hemorrhage has the highest incidence in the premature infants.Recent study indicates the incidence ofPeriventricular-intraventricular hemorrhage of the preterm infants close to 56.6%. With the improvement of medical treatment,the mortality rate of intracranial hemorrhage in the premature infants is obviously decreasing,but the survivors with intracranial hemorrhage often have neurologic sequelae.At present,intracranial hemorrhage has no effective therapy,so it's very important to obviate intracranial hemorrhage.We should know the risk factors of intracranial hemorrhage to prevent the premature infant occurrencing it.The development of the premature brain accompanies the growth of Gestational age.Some documents indicate less than 32 weeks of gestation is a independently risk factor of intracranial hemorrhage of the premature infants.In addition,domestic and overseas study indicates intracranial hemorrhage of the premature infants probably correlates with the following factors:A.mothers with disease of pregnancy-induced hypertension syndrome,anaemia, diabetes mellitus,heart disease and pulmonary disease may cause fetal intrauterine hypoxia,which will increase the incidence of intracranial hemorrhage;B.hypoxia;C.disequilibration of acid and base:metabolic acidosis,respiratory acidosis and respiratory alkalosis;D.electrolyte disturbances: hyponatremia and hypocalcemia;E.polycythemia;F.pathoglycemia;Gdisturbance of blood coagulation;H.mechanical ventilation;I.drug may influencing blood pressure and cerebral blood flow;J.affiliating neonatal respirator distress syndrome or scleredema neonatorum.Some literature still reports antepartum gravidas using dexamethasone or postnatal neonates using luminal may decrease the incidence of intracranial hemorrhage.Gestation age is a independently risk factor of premature infants with intracranial hemorrhage.To approach other perinatal risk factors,we studied 64 premature infants with intracranial hemorrhage diagnosed by cranial ultrasound and admitted between January,2005 to December,2006. Among the total, 22 patients'gestation age exceeded 34 weeks,20 patients'gestation age was less than 34 weeks but exceeded 32 weeks,and 22 patients'gestation age was less than 32 weeks. We also randomly selected 70 premature infants without intracranial hemorrhage at the same period as the control group.Among the total, 24 patients'gestation age exceeded 34 weeks,22 patients'gestation age was less than 34 weeks but exceeded 32 weeks,and 24 patients'gestation age was less than 32 weeks. Two groups'gestation age analyzed by the method of Chi-square test had no distinguished difference.We analyzed 33 factors with the method of single-factor analysis:mothers with disease of pregnancy-induced hypertension syndrome, antepartum gravidas using dexamethasone, mode of production,premature rupture of membrane,fetal intrauterine distress,amniotic fluid, placenta, umbilical cord,multiple gestation,asphyxia,birth weight, sexuality, anaemia,blood platelet,blood glucose, postnatal hypoxia, metabolic acidosis,respiratory acidosis, respiratory alkalosis, hyponatremia, hypocalcemia, blood coagulation, phototheray,aminophylline, dopamine, luminal, dexamethasone, naloxone,aspirate sputum, mechanical ventilation, affiliating pneumonia,neonatal respirator distress syndrome and scleredema neonatorum. After analysis,there were significant differences of 13 factors in two groups,including intrauterine embarrass, amniotic fluid, asphyxia,postnatal hypoxia, respiratory acidosis,hyponatremia, hypocalcemia,aminophylline, dopamine,luminal, dexamethasone, naloxone and aspirate sputum. Considerating factors might interact each other,which would influenc the accuracy of result,we analyzed 13 significant factors with the method of logistic regression analysis.The result manifested asphyxia,respiratory acidosis,hyponatremia and aminophylline were the risk factors of intracranial hemorrhage.Conclusions: asphyxia,respiratory acidosis,hyponatremia and amino- phylline have close relationship with intracranial hemorrhage. Hence,clinical doctors should prevent beforehand the risk factors of intracranial hemorrhage,then strictly palmar grasp the indication and dose of aminophylline.In addition,some relative research manifested other factors that have no statistical significance with intracranial hemorrhage analyzed by our medical case statistics are related with intracranial hemorrhage.So we should also pay attention to other factors.The survivors with severe intracranial hemorrhage often remain neurologic sequelae,and intracranial hemorrhage has no effective therapy,so it's very important to understand the risk factors of intracranial hemorrhage obviating intracranial hemorrhage.