Early Monitoring And Significance Of Heart And Brain Injury In Neonatal Asphyxia

BackgroundIn recent years,with the development of the medical technology such as obstetrics and intrauterine monitoring,the increasing cooperation between obstetrics and neonatology,and the continuous improvement of pediatric resuscitation technology,the morbidity and mortality rate of neonatal asphyxia were significantly declined.The success rate of recovery has also been significantly improved.However,the conditions of multiple organ damage induced by asphyxia remained challenging.Especially the most vulnerable parts to asphyxia,the brain and heart.The dysfunctions of these organ could bring deteriorated effects on the prognosis of neonatal asphyxia.Therefore,early detection of important organ(brain,heart)damage and clinical symptoms is conductive to treatment and prognosis of neonatal asphyxia,and the reduction of complications,suggesting its vital significances to clinical practice and society.ObjectiveThe main purpose of this study was to investigate whether Amplitude-integrated electrocephalogram(aEEG),Magnetic Resonance Imaging(MRI),Creatine Kinase-MB(CK-MB),and Creatine Kinase(CK)are early predictors of important organ(heart,brain)damage in the early stage of neonatal asphyxia,and explore the relationship between these predictors and the complications as well as their significance for the prognosis.MethodsRetrospective analysis:44 full-term neonates diagnosed with neonatal asphyxia in the Neonatal Intensive Care Unit(NICU)of Second Hospital of Shandong Universityfrom January 2017 to January 2018 are enrolled into this study which comprised of 32 cases of mild asphyxia group and 12 cases of severe asphyxia group.And 39 cases of non-asphyxia neonates were selected as the control group.Main observations:aEEG(normal,mild,moderate and servere);MRI(normal,mild and severe);CK-MB?CK(the level at admission and 6-8 days after admission);cardiac and brain complications;duration of treatment.Statistical analysis was performed using SPSS version 22.0 software.Results1.There was no significant differencebetween the control group(non-asphyxia group)and the case group(mild asphyxia group and severe asphyxia group)in terms of gestational age,birth weight,mode of delivery,gender,and maternal age.2.There was a positive correlation between the clinical grading of asphyxia and the grades of brain MRI and aEEG abnormality.The higher the degree of neonatal asphyxia was,the more serious the MRI and aEEG abnormality were.And the relationship between asphyxia and aEEG was closer than that of asphyxia and brain MRI.3.The incidence rate of hypoxic-ischemic encephalopathy(HIE)was higher in the severe asphyxia group than the mild asphyxia group(P<0.05).4.There was a positive correlation between HIE and the grades of brian MRI and aEEG abnormality,In other words,the occurrence rate of MRI and aEEG abnormality was significantly higher in the newborn who with HIE than in the newborns without HIE(P<0.05),MRI and aEEG results were nomal in most of the newborns without HIE.5.The levels of CK and CK-MB in the case group were significantly higher than those in the control group at the time of admission(P<0.05).6.The levels of CK and CK-MB declined significantly at 6-8 days after admission in the case group(P<0.05).7.There were no significant differences in the level of CK and CK-MB among the three groups(without asphyxia,mild asphyxia,severe asphyxia)at 6-8 days after admission(P<0.05).8.There were no significant differences in the incidence of congenital heart disease between the newborns without asphyxia and the newborns with asphyxia(P>0.05).9.The duration of treatment was significantly increased in neonates with servere asphyxia and newborns with HIE while comparing with the neonates without severe asphyxia and newborns without HIE,respectively.The length of treatment increases with the degree of abnormality of the aEEG and MRI.However the complication of heart disease could not affect the hospital stay(P>0.05).10.There was a positive correlation between the level of CK-MB at admission and the duration of treatment(P<0.05).The higher the level of CK-MB was at admission,the longer the hospital stay was.There was a negative correlation between Apgar scores and treatment time.The lower the Apgar score was,the longer the hospital stay was.And the trends of correlation were 10 min>5 min>1 min.The level of CK?CK-MB at 6-8 days after admission and the level of CK at admission are not related to hospitalization time(P>0.05).Conclusions1.aEEG and brain MRI may contribute to the diagnosis of brain injury early in neonates with asphyxia,and AEEG was superior to MRI in the judgment of the patient's state and prognosis.2.CK and CK-MB may contribute to the diagnosis of myocardial damage in neonates with asphyxia.3.The results of aEEG,MRI,the level of CK-MB at admission and Apgar score have vital implications for the short-term prognosis.