| Background and objectives:Peri-intraventricular hemorrhage(PIVH),as common intracranial lesions for early neonates born within a week,90%above PIVH occurred within the early neonatal period of one week after birth.,can lead to neonatal death and worse long-term prognosis of nervous system,such as hydrocephalus,epilepsy,mental-movement developmental disorder,cerebral palsy,etc.This study was conducted in the early neonatal period of one week after birth.Therefore,early detection and diagnosis of neonatal PIVH is the key to save patients' lives and improve patients' long-term quality of life.Though perinatal medicine developed gradually in recent years,improvement in the success rate of high-risk infants,the incidence of PIVH increased but no decreased because of the increased proportion of the high-risk newborns,early neonatal anatomical structure and all kinds of risk factors.PIVH early lack of specific clinical manifestations,so the study of PIVH-related factors,early clinical diagnosis,early intervention is of great significance.At present,most of the literature studies are risk factors for intraventricular hemorrhage in premature infants.Risk factors for intraventricular hemorrhage in early neonates are rarely reported in the literature,and analysis of their factors is not consistent.Therefore,this study collected a large number of clinical data for analysis,and studied the severity of relevant factors,the findings and other relevant research literature is complementary.By analyzing the risk factors of PIVH,help prevent the occurrence of bleeding,to avoid severe intraventricular hemorrhage,in order to reduce hydrocephalus,irreversible white matter damage and hemorrhagic infarction,reduce long-term neurological sequelae,improve the prognosis,to impro-ve the quality of life of children.Neonatal brain damage is the root cause of a variety of factors leading to severe cerebral hemodynamic disorders,leading to brain dysfunction.Through the monitoring of cerebral blood flow velocity and resistance index,it can provide the blood supply to the brain and help to judge the condition of the children.There are many literatures on cerebral hemodynamic changes in neonates with hypoxic-ischemic encephalopathy,but few studies have focused on cerebral hemodynamic changes in early neonates with PIVH.This study provides value clinical data of cerebral blood flowBrain ultrasound is currently preferred method of screening and diagnosing PIVH in China and developed countries.The fourth edition of practical neonatology has made clear that brain ultrasound has specific diagnostic value for PIVH,which is superior to CT and MRI.In this study,high-risk children with brain ultrasound routine examination to find different degrees of bleeding,especially the detection of asymptomatic cases.Clinical data were collected in the research of early neonates admitted in Liaocheng People's Hospital and had intraventricular hemorrhage.They were divided into the mild and severe groups to explore the related risk factors for intraventricular hemorrhage and its hemodynamic changes and to provide clinical experience for the early prevention and treatment and improving the prognosis.Method:1.Subjects and groupChoose during January 2013-December 2015,early neonatal in the Children's Hospital of Liaocheng,and they were screened at the first week by cranial ultrasonagraphy showed PVH-IVH cases.According to the Papile classification standard,grade ? and ? belong to mild intraventricular hemorrhage,grade ? and ?belong to severe intraventricular hemorrhage,namely,mild and severe groups.Patients in the control group had nonventricular hemorrhage.2.Equipment and inspection timeProfessional doctors using Italian Yum ultrasound diagnostic apparatus(probe frequency 5-7.5MHz)on the 1st,3rd and 7th day after birth children bedside brain ultrasound..3.Clinical data collectionBaseline perinatal factors information of infants was recorded,including gender,gestational age(GA),pregnancy complications(pregnancy with hypertension,diabetes mellitus),mode of delivery,birth weight(BW),Apgar score,neonatal respiratory distress(RDS),acidosis,patent ductus arteriosus(PDA),neonatal infection,coagulation function,intraventricular hemorrhage classification,cerebral hemodynamics parameters.4.Statistical analysisThe data were analyzed by SPSS23 statistical software.The metrological data according to the normal distribution are expressed as mean ? standard deviation(x ±s),the classification data are expressed as n(%),the count data are expressed in percentages and ratios,the multi-group ANOVA is used,Bonferroni correction.The classification data were analyzed by chi-square R*C chi-square analysis,and Bonferroni correction was used for comparison.Multivariate analysis used logistics regression analysis,the use of regression method of screening variables.The test level is a = 0.05.Result:1.Case informationThere were 1,360 early neonatal cases,and 175 cases were in compliance with the inclusion criteria.There were 129 cases of mild intraventricular hemorrhage,including 66 males and 63 females,birth weight(2550 ± 312)g;46 cases of severe intraventricular hemorrhage,including 22 males and 24 females,birth weight(2302 ±421)g;132 cases of non-intraventricular hemorrhage group(control group),including 75 males and 57 females,birth weight(2712 ± 302)g.There was no statistically significant difference in sex between the three groups(X2=1.441,P = 0.487).There was significant difference in birth weight among the three groups(P<0.001).2.Study on influential factors of early neonatal intra-ventricular and parenchymal hemorrhages2.1 Comparison of influential factors of intraventricular hemorrhage among the early neonatesChi-square analysis showed that,low birth weight infants,intrauterine distress,pregnancy-induced hypertension,preterm birth,neonatal asphyxia,neonatal respiratory distress syndrome,patent ductus arteriosus,acidosis(PH<7.2 or BE<-6),coagulation dysfunction(PT,APTT prolongation or FIB decrease),neonatal infection(P>0.05)and other 10 factors in the three groups the difference was statistically significant.There was no correlation between gender,gestational diabetes mellitus,and the incidence of intraventricular hemorrhage(P>0.05).We introduced a statistically significant variable data into the bonferroni correction,which was statistically significant.The results showed there were significant differences in 8 factors between control group and mild group,low birth weight,intrauterine distress,premature delivery,neonatal asphyxia,neonatal respiratory distress syndrome,patent ductus arteriosus,acidosis and coagulation dysfunction.There were significant differences between the mild group and the severe group in coagulation dysfunction,intrauterine distress,acidosis and neonatal infection.There were significant differences between the control group and the severe group,low birth weight infants,intrauterine distress,premature delivery,neonatal asphyxia,neonatal respiratory distress syndrome,arterial catheters,acidosis,coagulation dysfunction,neonatal infection and pregnancy-induced hypertension.2.2 Multivariate logistic regression analysis of influential factors of early neonatal intraventricular hemorrhage2.2.1 Multivariate Logistic Regression Analysis between Control and MildMultivariate logistic regression analysis was used to analyze the variables of statistical significance in univariate analysis.The results showed that preterm birth,neonatal asphyxia,acidosis,NRDS,patent ductus arteriosus and coagulation dysfunction were independent risk factors for mild intraventricular hemorrhage.2.2.2 Multivariate Logistic Regression Analysis between Control and Severe GroupsMultivariate Logistic regression analysis was used to analyze the statistically significant variables in univariate analysis.The results showed that acidosis,coagulation dysfunction,patent ductus arteriosus,NRDS,neonatal asphyxia and neonatal infection were independent risk factors for severe intraventricular hemorrhage.2.2.3 The control group,mild group and severe group were analyzed by multivariate logistic regression analysisThe results of univariate logistic regression analysis showed that acidosis,neonatal asphyxia,coagulation dysfunction,patent ductus arteriosus,NRDS,neonatal infection,and intrauterine distress were the significant variables Intraventricular hemorrhage severity independent risk factors.3.Cerebral hemodynamic changes3.1 Changes of systolic blood flow velocity in children with cerebralThere were significant differences between the control group,the mild group and the severe group.Within the first day,the third day and the seventh day was statistically significant.Further comparisons between the two groups were shown there was significant difference in the third day' Vs between the control group and the mild group.The Vs in the mild group was lower than that in the control group.The difference between the mild group and the severe group,the control group and the severe group was statistically significant.There were significant differences in Vs among the three time periods.The Vs in the severe group was lower than that in the mild group and the control group,which was statistically significant.3.2.Changes of diastolic blood flow velocity in children with cerebralThere were significant differences between the control group,the mild group and the severe group.Within the first day and the seventh day was statistically significant.Further comparisons between the two groups were shown there was significant difference in the first day' Vd between the control group and the mild group.The Vd in the mild group was lower than that in the control group.There were significant differences in Vd between mild group and severe group,and between control group and severe group,and Vd was lower in severe group than that in mild group and control group,which was statistically significant.3.3 The change of cerebral blood flow resistance index in each groupThere were significant differences between the control group,mild group and severe group in the first day and the seventh day,which was statistically significant.Compared with the control group and the mild group,there was a significant difference in the RI between the two groups.The RI of the mild group was higher than that of the control group.There was significant difference in RI between mild group and severe group,and between control group and severe group,RI was significantly higher in severe group than that in mild group and control group at the 1st and 7th day,which was statistically significant.Conclusion:1.Influential factors of PIVH in early neonatesa.Low birth weight infant,fetal distress,premature birth,neonatal asphyxia,NRDS,PDA,acidosis,coagulant function abnormality and neonatal cerebral hemorrhage related.Pregnancy-induced hypertension and neonatal infection severe intraventricular hemorrhage are also relevant,but there were no correlation between the mild ventricular hemorrhage,fetal distress,acidosis,infection abnormal blood coagulation function and sever hemorrhage.b.Premature birth,neonatal asphyxia,acidosis,NRDS.PDA and abnormal blood coagulation were the high risk factor for mild ventricular hemorrhagec.Acidosis,abnormal coagulation function,PDA,neonatal asphyxia and neonatal infection were the high factor of severe ventricular hemorrhaged.Acidosis,neonatal asphyxia,abnormal coagulation function,PDA,NRDS,neonatal infection and fetal distress were the high risk factors for the severity of hemorrhage2.Changes of cerebral hemodynamics in early neonatesa.There was no significant difference in diastolic blood flow velocity and resistance index between mild PIVH group and severe PIVH group and normal group on the third day after birth.b.The rate of decrease of cerebral blood flow velocity and the increase of resistance index in severe PIVH group were more obvious than those of mild PIVH group.c.Cerebral hemodynamics in the mild PIVH group returned to normal 3 days after birth,but cerebral hemodynamics in the severe PIVH group still showed abnormal hemodynamic changes in the first week after birth. |
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