The Relationship Between Brain Injury In Preterm Infants And Perinatal Factors

[Objectives] Investigate the correlation between perinatal factors and brain injury in preterm infants with gestational age≤34W, provide evidence for perinatal prevention and early intervention of brain injury in preterm infants ,and to improve the quality of life of premature infants.[Methods] In this study, we collected the premature with gestational age ≤34W who borned in the First Affiliated Hospital of Kunming Medical University Obstetrics Department ,time from June 1, 2014 to October 31, 2016.30 perinatal factors were collected , including factors of antepartum-intrapartum -postpartum period.According to cranial ultrasound and MRI examination results get intraventricular hemorrhage group / periventricualr leukomalacia group / combined injury /without brain damage group. To investigate the correlation between different types of brain injuries and perinatal factors; According to different diagnostic types, intrauterine infection was divided into histology chorioamnionitis and clinical chorioamnionitis,according to different diagnosis types of pregnancy hypertension were divided into histological with PIH, severe gestational hypertension (severe preeclampsia and eclampsia), mild gestational hypertension (gestational hypertension, mild preeclampsia), to analyze the influence of two factors with brain injury .There were statistically significant factors for univariate analysis, then make the Multivariate Logistic regression analysis,Univariate analysis was performed by x2 /t test, and correlation analysis was performed by Logistics regression model.[Results]A total of 392 cases of premature infants were included in <34Weeks,1 .Incidence of brain injury in premature infants: the total incidence of brain injury in preterm infants was 42%(165/392), with intraventricular hemorrhage 102 cases(26.0%), periventricualr leukomalacia 32cases (8.2%), intraventricular hemorrhage with periventricualr leukomalacia 31 cases (7.9%) . Comparison of different gestational age (<32/32-34W) the incidence of brain injury in preterm infants, results show that the smaller gestational age, the risk associated with brain injury was higher(x2=12.688,p=0.000);Comparison of different body weight(<1500g/1500-2000g/>2000g) the incidence of brain injury in preterm infants, results showed that the weight was small, occurrence of combined injury was higher (X2 =17.258, P = 0.000); 2 .Correlation Study of brain injury and perinatal factors:①In the hemorrhagic injury: the logistic regression model get: severe preeclampsia(OR=2.287, 95%CI: 1.099-4.758, P < 0.05), BPD (OR=2.670, 95%CI:1.418-5.029, P< 0.01), late-onset sepsis (OR=2.318, 95%CI: 1.234-4.357, P < 0.01), mechanical ventilation (OR=1.936,95%CI: 1.067-3.517,P < 0.05) were the risk factors of intraventricular hemorrhage ;② In the periventricualr leukomalacia: the logistic regression model get: clinical chorioamnionitis (OR=9.864, 95%CI: 2.364-41.155,P<0.05), asphyxia (OR=3.319, 95%CI: 1.394-7.906, P<0.05), Cord blood pH<7.0(OR=4.953,95%CI:1.527-13.024, P<0.05) were the risk factors of periventricualr leukomalacia; ③In the combined injury:the logistic regression model get: severe preeclampsia ((OR=4.213, 95%CI: 1.473-12.052, P<0.05), mechanical ventilation(OR= OR=5.029,95%CI: 1.914-13.193,P <0.05) were the risk factors of intraventricular hemorrhage with periventricualr leukomalacia.④Effects of different diagnostic types of intrauterine infection on brain injury in preterm infants, the result shows that the influence of different types of chorioamnionitis in premature infant brain injury were differences ,especially in periventricualr leukomalacia and combined injury (X2 =6.440/5.538,P<0.05); ⑤Effects of different diagnostic types of pregnancy hypertension on brain damage in preterm infants, the results showed that different types of gestational hypertension had different effects on premature infants with hemorrhagic and combined brain injury (X2 = 17.017/6.009, P = 0/0.047).Comparison between groups showed in hemorrhagic injury, there were differences in histological、severe gestational hypertension and mild gestational hypertension (X2 =13.729/15.206, P = 0), and histology of PIH and severe gestational hypertension had no significant difference (X2= 0.156, P = 0.963).In the combined injury,the results showed that there was a significant difference between mild and severe preeclampsia(X2 = 4.59, P = 0.032),histology、mild PIH and severe PIH had no statistically significant difference (X2 = 2.121/0.142, P > 0.05). For periventricualr leukomalacia was not statistically significant.[Conclusions] 1 .In our hospital,The incidence of brain injury in preterm infants<34W was higher get 42%, and the smaller the gestational age, the smaller the body weight, the higher the incidence of combined brain injury in preterm infants.2.Severe preeclampsia and eclampsia, clinical chorioamnionitis, mechanical ventilation, BPD and asphyxia, cord blood pH<7.0 were risk factors of perinatal brain injury,There were different risk factors for different types brain injury. Different degrees of intrauterine infection and pregnancy induced hypertension have different effects on brain injury ;3. Prenatal care was strengthened, reasonable control of blood pressure, reduction of intrauterine infection, increase recovery rate of asphyxia and rational use of respiratory support during the neonatal period can reduce the occurrence of brain damage in preterm infants.