| In recent years, the role of intrauterine infection in preterm is taken more attention. Many data show that prenatal infection were assiciated with preterm. The term of intrauterine infection is the fetus infection caused by the pathogen infection in pregnant women. During pregnancy the mother to exogenous antigen--half of the fetus" graft" tolerance induced the immune globulin level change,the polymerph-onuclear leukocyte chemotaxis and adhesion was inhibited since mid trimester of pregnancy, while there may be change cell immunity, resulting in pregnant women and fetuses are vulnerable to a variety of infections and infection disease, lead to intrauterine infection。Intrauterine infection can cause a range of adverse conse-quences, and the extent of the harm is related with the time of intrauterine infection occurred, the type of pathogenic microorganisms and maternal status and other factors. Infections occur in the first trimester is generally believed that the greater the damage abortion, congenital malformations; infection occurs in the third trimester of pregnancy and lead to preterm labor, premature rupture of membranes, neonatal in-fections and other adverse consequences. Hypoxic-ischemic encephalopathy due to perinatal hypoxic-ischemic brain injury is one of the important reasons that cause neonatal mortality and sequelae occurred. Owing to the neonatal brain is immature, the compensatory ability is insufficient, and prone to damage by a variety of factors, especially in hypoxic-ischemic factors. There are reported in the literature, in animal experiments, intrauterine infection and hypoxia can cause fetal rat brain injury, brain damage can aggravate both separately role of intrauterine infection and hypoxia exist. Many epidemiological studies have shown that chorioamnionitis can causes neurological abnormalities and the incidence of cerebral palsy, its mechanism involving macrophage activation and the precursor of inflammatory factors change. Intrauterine infection can increase the cytokines (tumor necrosis factor, interleukin, etc.) synthesis and release, cytokines from the uterus and placenta can stimulate the fetus brain glial cells (microglia and astrocytes) generating a large number of cytokines, the joint action of the two parts cytokines, resulting in the proliferation of glial cells.In order to maintain the stability of the nervous system,when the nervous system is damaged,the glial cells reactive hyperplasia, to rebuild this homeostasis. Glial cells damage and glial cells proliferated to fill the vacancy left by neuronal necrosis, affect the nervous system function, severely the cerebral palsy will occur. The occurrence of preterm children with white matter damage mechanism is unclear. The study showed that intrauterine infection is closely related to preterm white matter damage. Intrauterine infection is an important factor for preterm birth, cytokines involved in preterm delivery after intrauterine infection, and, through the activation of astrocytes in the white matter tissue, microglia, oligodendrocytes, and affect their immunological function, causing pathophysiological changes of white matter tissue, leading to the occurrence of white matter injury in premature children. Intrauterine infection is closely related to nervous system injury. Through the retrospective analy-sis of the clinical data which are carried out the placental pathology examination, compared with the group with chorioamnionitis and the group without chorioam-nionitis, to find out the brain injury difference in two groups. To explore the corr-elation between intrauterine infection and neonatal brain injury, to understand whet-her separate intrauterine infection can cause brain damage,and whether intrauterine infection complicated with hypoxic intrauterine can increase the incidence of brain injury. as well as intrauterine infection early judgment,and investigate the value of the C-reactive protein in early diagnostic of intrauterine infection.ObjectiveTo analye the value of CRP in the neonatal intrauterine infection,to investigate the relationship of the first three days CRP and intrauterine infection,and investigate the intrauterine infection and neonatal brain damage,MethodsRetrospectively analyzed the cases labor in our hospital obstetric from January2007to December2011, and the placenta were done pathologic examination, and the newborn were transferred to Neonatology.The placental pathologic diagnosis of chorioamnionitis, fetal meningitis, amnionitis, chorioamnionitis divided into infection group, pathological examination with no inflammation divided into non-infected group. To collect the two groups’clinical information, including gestational age, birth weight, fetal heart rate, amniotic fluid, Apgar scores, the first day and the third day CRP after born, the results of blood routine examination and neuroimaging examination. Compared the two groups of preterm birth rate, ultrasound, brain MRI examination and CRP, the white blood cell and CRP between the groups and the difference days,and analysis the correlation between CRP and birth weight,gestational age. Statistics analysis: All data were analyzed using the SPSS13.0.All data were expressed as mean±standard deviation (X±S). count data with the χ2test, measurement data using t test. The two groups of preterm birth rate comparison,ultrasound and brain MRI SCAN positive results rate comparison, use the x2test; brain MRI findings with birth situation (gestational age,birth weight, fetal heart rate, amniotic fluid, Apgar score) use Binary Logistic regression model analysis; In the two groups after first day and3day CRP contrast, using paired t test; compared the different days CRP of two groups, white blood cells count, using independent sample t test; correlation analysis of CRP and gestational age and birth weight children, using bivariate correlation analysis. P<0.05presents statistics different.Results1. the cases labored in obstetric in our hospital from January2007to December 2011, and lined pathological examination of the placent, the cases of placental pathology diagnosis of fetal meningitis amnionitis chorioamnionitis and chorioamnionitis were658, which transferred to Neonatology350cases, the examination of placental pathology diagnosis of no inflammation were1368cases, in order to balanced the number of two groups, using simple random sampling method, extracted658cases, of which271cases transferred to our hospital neonatology.In the end, the total number of cases was621, the infected group (n=350), and non-infected group (n=271). Preterm delivery. in infected group were196cases,99cases of non-infected.The preterm birth rate of infection group was greater than the non-infected group(P=0.000),and had a high average birth weight than the non-infected group (P=0.000)2. Of the651infants in the study population, inspect the ultrasonography in175cases, normal in138cases,37cases showed HIE. There were7cases underwent CT examination, normal in3cases,4cases showed HIE. The MRI examination in117cases, normal48cases, HIE64cases,5cases of premature infant brain changes.compared the inspected results of ultrasonography and MRI scan, there were statistical differences, the MRI had the high positive rate of brain injury.3. Of the651infants in the study population,had no perinatal hypoxic history, inspect brain MRI examination,16cases of non-infection group, infection group with27cases. Two groups of children with cranial ultrasonography and cranial MRI examination results were compared with no statistical significance (MRI,P=0.907, ultrasonography,P=0.652.).4. Had perinatal hypoxic history, inspect the cranial MRI examination,36cases of non-infection group, infection group with45cases. Compared the results of MRI examination between infection group and non-infection,there were significance differences,inrauterine infection were correlation with the MRI with brain injury (P=0.039, OR,2.750,95%confidence interval1.086～6.964).5. Risk factors analysis, the results of the MRI and the gestational age, birth weight, fetal heart rate, amniotic fluid, born after1minute and5-minute Apgar score of infants used Binary Logistic regression model analysis showed brain MRI brain injury correlated with5-minutes Apgar scores,the5-minutes Apgar score as a protective factor.6. Of all the infants, the were479cases of the first day after birth lined CRP examination, including294cases of infection group (placental pathologic examination positive),185cases of non-infected group (placental pathologic examination was negative); review CRP were261cases in the third days after birth,178cases of infection group,83cases of non-infected group.there were significant difference of the first day CRP between infection group and non-infected group (P=0.0017), there were no significant difference of the third day after birth CRP (P=0.984); there were significant difference of the first day and the third day CRP in infection group (P=0.02), in non-infected group, a statistically significant difference (P=0.003); The CRPof the first day after birth is not related to gestational age (P=0.569, r=0.021)and weight (P=0.379, r=0.029), the CRP of third day after birth,were being related with gestational age (r=0.170, P=0.000)and body weight (r=0.164, P=0.000), but there was no strong correlation(correlation coefficient of less than0.5).ConclusionsIntrauterine infection can lead to premature birth, which is already recognized, the case analysis showed the group infection had higer preterm birth rate than non-infected group, consistent with the conclusions. Judgment the neonatal brain lesions,the ultrasonography and cranial MRI are the most commonly used, both have their advantages and insufficient, the case analysis shows the cranial MRI diagnosis of neonatal brain injury was higher than ultrasonography.Different operator maked ultrasonography may have different results. Cranial MRI examination is more objective, high accuracy. There were little infants conducted brain CT, and brain CT radiation is intense,is not suitable for newborn,imaging diagnosis of brain injury should be mainly use cranial MRI. The brain MRI results had on significantly difference between the two groups of infants with no perinatal hypoxia,while had significantly difference between the two groups of infants with perinatal hypoxia, promped that intrauterine infection was significant relationship with the brain damage check by cranial MRI (P=0.039, OR,2.750,95%confidence interval1.086to6.964),the con-fidence interval does not contain1, intrauterine infection is a risk factor for neonatal brain injury. The data showed intrauterine infection alone does not increase the incidence of brain injury, but intrauterine infection is a risk factor for brain damage in infants with hypoxic. Binary Logistic regression model analysis showed brain MRI brain injury corr-elated with5-minutes Apgar scores.The recovery Within five minutes is closely related to the infants with hypoxia history. Judge for early intrauterine infection, for the infants with intrauterine infection, check the CRP of the first day after birth, the majority is not elevated, the third day review increased than the first day after birth. The CRP would have a rapid increase in acute inflammation or tissue damage after4-6hours,36-50hours would reach the peak.So considering the infants with intrauterine infection, immediately line CRP check,after admission have no significantly elevated, it is recommended2-3day after birth to review the CRP, or line the calcitonin or interleukin after birth, consolidated to determine whether the infection existence. The first day after birth leukocytes was no statistically significant between two groups, the total number of white blood cells can not accurately reflect the presence of intrauterine infection. The CRPof the first day after birth is not related to gestational age and birth weight, the CRP of third day after birth were being related with gestational age and birth weight, but the correlation is not close, the gestational age and weight had no significant effect on CRP. |
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