A Study On The Relationship Between Levels Of Serum Act-a,cox-2 And Preterm Neonate

Premature brain injury is mainly manifested as periventricular white matter damage and periventricular-intraventricular hemorrhage,which is related to infection, hypoxia-ischemia,oxidative stress or inflammation in addition to its own developmental factors,such as,immature cerebrovascular / ependymal anatomical defects,developmental deficience of oligodendrocytes and axons,lack of endogenous growth factors.The present research detected levels of serum ACT-A,COX-2 after birth in premature infants,NBNA,ABR,OAE test were done at corrected gestational age of 40 weeks and CDCC test at 6 months after corrected gestational age.we compared levels of serum ACT-A,COX-2 among asphyxia,infection and normal groups,and levels of ACT-A,COX-2 in NBNA,ABR,OAE or CDCC normal and abnormal groups,try to provide a theoretical evidence for early diagnosis and intervention of premature brain injury.Objects:Selection criteria:gestational age≤37 weeks,no history of genetic metabolic diseases and congenital malformations,with parents consent.Gestational age,birth weight and gender of premature infants among each groups had no statistically significant difference.Category 1:All the infants were divided into asphyxia,infection and control group, according to whether they had asphyxia or infection during or after delivery.Asphyxia group(40 cases).Diagnostic criteria:①With antenatal high risk factors,such as hypertention or diabetes during pregnance,intrautarine fetal distress, meconium contaminated amniotic fluidⅡ-Ⅲ°,placenta previa,placental abruption and antenatal bleeding;②Low Apgar scores:Both of 1 minute and 5 minutes scroes were＜7;③Umbilical arterial blood pH＜7.00,or pH＜7.20 when the②,④,⑤conditions present;④Hypoxic-ischemic organ injuries(at least one organ damaged);⑤Exclusion of other conditions that can cause low Apgar scores,or the②-④items could not be explained by other disease.Infection group(20 cases).Routine blood test and CRP were done three days after birth.①WBC＞20×10~9 and CRP＞10mg/L;②WBC＞20×10~9 or CRP＞10mg/L infants born with premature rupture of membranes,had ferver,lower tempreture or poor reaction,feeding problerm or other signs of infection;③We didnot find the syndrome of infection,but it is valid when we use antibiotic to infants;④infants are without perinatal asphyxia,Control group(20 cases).They are no intrautarine fetal distress,asphyxia or antenatal high risk factors,without infections(NEC,neonatal pneumonia,etc.), without respiratory disease(RDS,apnea),without circulatory system disorders (polycythemia,hypotension,hypovolemia,neonatal scleredema,bradycardia) and without coagulation system disorders.Category 2:The infants with asphyxia or infection were divided into normal and abnormal groups according to follow-up results.Methods1.2.0 ml blood samples were taken from all the premature infants 1st day and 3rd day after birth,centrifuged for 10 minutes with 3000 r/min,separated for serum, marked and preserved in -70℃refrigerator.Serum COX-2,ACT-A concentrations were detected using ELISA Method.2.NBNA and hearing screening(OAE+ABR) were done at the corrected gestational age of 40w for all the infants.NBNA≥37 points was considered as normal, and＜37 points was abnormal.OAE abnormal,with one or double ears could not pass. ABR abnormal,lack ofⅠ,Ⅲ,Ⅴwaves,or the latent periods,intervals,Ⅴwave threshold beyond average plus three standard deviation.3.CDCC was done at 6 months after corrected gestational age of 40 w.Mental Development Index(MDI) and Psycho-motor Development Index(PDI) were recorded.≥80 scores was considered as normal,and＜80 scores was abnormal.Statistical analysis:All the data were presented as mean±SD,t test or t' test was used for comparing variance among groups.All the data were calculated by SPSS10.0 statistical analysis software.P＜0.05 was considered as statistically significant.Results:1.Comparision of Serum ACT-A,COX-2 levels among groups:(1) Serum ACT-A,COX-2 levels at 1st day and 3rd day after birth both in asphyxia and infection groups were significantly higher than that in control group(P＜0.05).(2) Serum ACT-A,COX-2 levels in asphyxia were significantly higher than infection group(P＜0.05).2.Changes of serum ACT-A,COX-2 levels in each group:In asphyxia and infection group,serum ACT-A,COX-2 levels at 1st day after birth were significantly higher than that of control group(P＜0.05).Serum ACT-A levels at 3rd day after birth continued to rise,COX-2 levels decreased at 3rd day,but still higher than that of control group(P＜0.05).In control group,no difference of serum ACT-A,COX-2 levels were found between 1st day and 3rd day after birth.3.Comparision of serum ACT-A,COX-2 levels at 1st day after birth between prognose normal and abnormal groups:Serum ACT-A,COX-2 levels at 1st day after birth of NBNA,ABR and CDCC abnormal infants were higher than that of normal groups.Serum ACT-A levels at 1st day after birth of OAE abnormal infants were higher than that of normal group,but not the serum COX-2 levels.Conclusion:1.Serume ACT-A,COX-2 levels increased in premature infants with asphyxia and infection.2.Serume ACT-A,COX-2 levels of 1st day after birth was related to short or long term neurological outcome.They could be selected as an early indicator of neonatal brain injury.