Study On The Related Factors Of Hydrocephalus After Intracranial Hemorrhage In Premature Infants

Background and ObjectiveIntracranial hemorrhage(ICH) is a common kind of disease which can caused serious brain damage in neonates,It is more common in premature infants,the smaller the gestational age,the higher the incidence rate.Those survivors often had different types and levels of neurologic sequelaes,such as Hydrocephalus,Cerebral palsy,Epilepsy,vision or audition disorder,Mental and Motor retardation,and so on.The sharply deterioration can result in death in a short period of time.In recent years,along with the development and improvement of medicine technology of Perinatal,But,As a result,the incidence of intracranial hemorrhage continued unabated,because of the increased prematurity of very low birth weight or extremely low birth weight infants,The incidence rate of intracranial hemorrhage was associated with the anatomic characteristics of Nervous system and physiological features in premature infants and a variety of perinatal high risk factors. Hydrocephalus after intracranial hemorrhage was the most common and serious complication in neonates,especially in premature infants with intracranial hemorrhage,the incidence rate was 25%~35%,which mainly occured in the grade III or IV intracranial hemorrhage,it showed that the bilateral lateral ventricle,the third ventricle and the fourth ventricle were more and more broadened.The hydrocephalus was usually occurred in 2 ~ 3 weeks after intracranial hemorrhage in neonates,The primaryly clinical manifestations were:the increasingly enlargement of head circumference,the enlargement or bulge of bregmatic fontanel,the separation of cranial sutures and seriously increased intracranial pressure could caused sunset syndrome in patients’ both eyes,and so on.Diagnosis mainly depend on imaging examination,such as Ultrasound,CT,MRI,and so on,Ultrasound with its peculiarly advantages was becomed the main diagnostic method in neonatal hydrocephalus.At present,the treatment for hydrocephalus still remained very difficult,and the total efficacy was poor,Therefore,the neurodevelopmental prognosis was poor too,they often remained different types and levels of neurologic sequelaes who had survived in the end,which was a grievous hidden trouble to influence on the quality of the whole population in our country.The process of the occurrence of hydrocephalus after intracranial hemorrhage in premature infants may be associated with various affected factors.By collecting the clinical datas of the neonates who were admitted to the Neonatology after birth were enrolled of the First Affiliated Hospital of Zhengzhou University of Neonatology,and bedside cranial ultrasound showed the presence of intracranial hemorrhage in premature infants in this study,The purpose is to analysis the factors which related to intracranial hemorrhage secondary to hydrocephalus in preterm infants,And measure the ventricle size of grade Ⅲ or Ⅳintracranial hemorrhage for dynamic analysis,so that providing more clinical experiences for the prevention or treatment of intracranial hemorrhage secondary to hydrocephalus. Materials and methods 1 The research objects and groupingThe present study was conducted during the period of 2012 June to 2014 Sep,the premature infants who were admitted to the Neonatal Intensive Care Unit(NICU) of the First Affiliated Hospital of Zhengzhou University after birth were enrolled and Bedside cranial ultrasound showed intracranial hemorrhage.Intracranial hemorrhage were divided into 4 levels.They were divided into two groups according to whether secondary to hydrocephalus after intracranial hemorrhage,Preterm infants with hydrocephalus were enrolled as hydrocephalus group,and preterm infants without hydrocephalus were simultaneously enrolled as non-hydrocephalus group. 2 Clinical data collectionRecording the relevant clinical data of the patient with intracranial hemorrhage as basic information,perinatal factors,and laboratory test results of the patients who were selected,including gender,gestational age(GA),birth weight(BW),the Apgar score,pregnancy complication(hypertension and diabetes mellitus),respiratory distress syndrome(RDS),heart failure(HF),patent ductus arteriosus(PDA),neonatal infection,the biomarker of HF(the plasma N-terminal pro-brain natriuretic peptide,NT-pro BNP),blood gas analysis,blood coagulation function,platelet,grade of intracranial hemorrhage,the indicators of ventricular size(anterior horn of lateral ventricle width,ventricular body diameter,posterior horn of lateral ventricle oblique diameter,the ratio of cornu posterius ventriculi lateralis,the third ventricle and the fourth ventricle).Those neonates with incomplete data of clinical and/or accessory tests were excluded at last.3 Statistical analysisThe establishment of a data base with Excel software,Applying the statistical software of SPSS version 17.0 for data analysis.The quantitative data accord with normal distribution can be expressed with mean and standard deviation(x±s),using independent samples t test for the gestational age and birth weight comparation between the two groups,the one-way analysis of variance(ANOVA) was performed in multiple groups,the count data expressed as percentage and rate,comparison among groups used Chi-square test,Single factor analysis and multivariate Logistic regression analysis were used to analysis the relevant factors for secondary to hydrocephalus after intracranial hemorrhage in neonates. Result1 General resultA total of 1052 cases were collected in this study,the total of premature infants which conformed to the inclusion criteria was 244 cases(Among of the 244 cases,grade III of ICH was 212,32 cases were grade IV of ICH).The cases of hydrocephalus group was 59(43 males and 16 females),The mean of gestational age was(29.6 ± 2.4) weeks(range 25.4 to 34.0weeks),the mean of Birth weight was(1230 ±550) g(range 560 to 3100g).185 cases were included in the non-hydrocephalus group,(112 males and 73 females),The mean of gestational age was(32.0 ±1.6) weeks(range 27.0 to 34.0 weeks),the mean of birth weight was(1650 ±409) g(range 760 to 3000g).The difference of sex ratio between the hydrocephalus and non-hydrocephalus groups had no statistical significant(c2=2.94,P=0.086),the difference of gestational age(t=8.806,P<0.001)and birth weight between(t=6.275,P<0.001)the two groups had statistical significant. 2 Single factor analysis of the related factors of hydrocephalus after hemorrhage in premature infantsIn this study,Single factor analysis showed that 11 factors were related with hydrocephalus after intracranial hemorrhage in premature infants,including gestational age<32 weeks,birth weight <1500g,severe asphyxia,RDS,neonatal infection,heart failure,PDA,acidosis(PH<7.2or BE<-6),thrombocytopenia(<100×109/L),coagulation abnormalities(PT or APTT prolonged or FIB decreased),grade Ⅲ or Ⅳ of intracranial hemorrhage,the difference of those factors between the two groups had statistical significant(all P <0.05,c2=6.59 ~ 106.16).but gender(male) and pregnancy complication(hypertension and diabetes mellitus),the two factors had nothing to do with the occurrence of hydrocephalus in premature infants(all P >0.05).3 Multivariate Logistic regression analysis of the related factors of hydrocephalus after hemorrhage in premature infantsMultivariate Logistic regression analysis indicated that gestational age <32.0 weeks,acidosis(PH<7.2 or BE<-6),grade Ⅳ of ICH,grade Ⅲof ICH,severe Resultasphyxia,coagulation abnormalities(PT or APTT prolonged or FIB decreased),thrombocytopenia(<100×109/L) were its risk factors for hydrocephalus after intracranial hemorrhage in premature infants(all P <0.05) and the odds ratio(OR) values were 20.462,11.686,10. 004,6.914,5.803,3.379,1.758.4 the comparison of lateral ventriculomegaly degree of two groups(the ratio of cornu posterius ventriculi lateralis)According to the grade Ⅲ or Ⅳ of intracranial hemorrhage,the ventricle size of hydrocephalus group was higher than the non-hydrocephalus group and the broadening of lateral ventricle had achieved the high limit in the first 2~3 weeks, Rather than the non-hydrocephalus,the variation tendency along with the time had no obviously changed,its difference has statistical significance.The Bilateral ventricles became wide progressively was closely related to the occurrence of hydrocephalus. Conclusion1 gestational age<32 weeks,birth weight <1500g,severe asphyxia,cesarean section,RDS,neonatal infection,heart failure,PDA,acidosis,thrombocytopenia, coagulation abnormalities,grade Ⅲ or Ⅳ of intracranial hemorrhage were related to hydrocephalus after intracranial hemorrhage in premature infants.2 gestational age <32.0 weeks,acidosis,severe intracranial hemorrhage(grade Ⅲor Ⅳ),severe asphyxia,coagulation abnormalities,thrombocytopenia were its highly risk factors for hydrocephalus after intracranial hemorrhage in premature infants.