| 1.Background and Objection1.1 BackgroundPremature infants with brain injury mostly occur in the perinatal period,and penventricular-intraventricular hemorrhage(PVH-IVH)is the most common.Disease itself and its neurological sequelae are the main causes of premature infants'early death,intellectual and motor development disorders.S100-beta protein(S100?)synthesized and secreted by the central nervous system,is a specific protein of the central nervous system.Studies abroad have shown that the serum concentration of S100? in premature infants with PVH-IVH is significantly higher than that in climical,laboratory or ultrasound diagnosis.1.2 ObjectionThe purpose of this study was to explore the relationship between serum S100? and gestational age and the incidence of PVH-IVH.The changes of important time points during the whole process were evaluated from the time before onset to the time after discharge.The information of non-PVH-IVH premature infants was collected as control group at the same time.To explore the specificity of serum S100?in premature infants with PVH-IVH,so as to early warn premature infants with intracranial hemorrhage injury and guide clinical treatment.2.Materials and Methods2.1 Research objectFrom August 2018 to January 2019,premature infants aged 26-32 weeks were selected from the neonatal intensive care unit(NICU)of Shenzhen Maternal and Child Healthcare Hospital.The age of admission was within 1 day afterbirth.2.2 MethodsPremature infants in the study were collected 1-2 ml of arterial blood on fasting at 1,3 and 7 days after birth.150 premature infants were examined by cranial ultrasound on the 3rd,7th and 10th days or every 1-2 weeks after birth according to the need of the condition.The fetal age was corrected nearly 40 weeks or before normal discharge.According to the results of cranial ultrasound,the patients were divided into two groups.The case group was a group of premature infants with PVH-IVH,and the control group was a group of premature infants without PVH-IVH.The patients were divided into mild PVH-IVH group(grade ?,?)and severe PVH-IVH group(grade ?,IV)according to Papile grading method.There were 8 cases in mild PVH-IVH group.Premature infants with gestational age of 26-28 weeks were selected for comparison between groups.Case group 1 was a group of premature infants with PVH-IVH and control group 1 was a group of premature infants without PVH-IVH.A comparison was made among the groups of 28-30 weeks of gestational age.The case group 2 was the group of premature infants with PVH-IVH,and the control group 2 was the group of premature infants without PVH-IVH.3.Result3.1 Serum levels of S100? in normal early premature infants at different gestational and postnatal agesThe 95%CI of the first day,the third day and the seventh day of 26-28 weeks were 0-611.30 pg/ml,0-375.38 pg/ml and 0-342.45 pg/ml,respectively.At 28-30 weeks of gestation,95%CI was 0-571.85 pg/ml,0-333.46 pg/ml and 0-391.56 pg/ml,respectively.95%CI at 30-32 weeks of gestation was 0-563.60 pg/ml,0-434.07 pg/ml and 0-712.27 pg/ml,respectively.The results showed that there was no significant difference between serum level of S100P and gestational age(R = 0.031,P = 0.074>0.05).The serum level of Si00? was different in different age groups(R=-O.129,P=0.022<0.05).3.2 Comparison between case group and control groupThe serum concentration of S100? in the case group was not higher than that in the control group on the first day,the third day and the seventh day after birth.There was no significant difference in the serum concentration of S100? between the two groups on the first day after birth,the third day after birth and the seventh day after birth(Z=-0.456,P=0.648;Z=-0.231,P=0.817;Z=-1.042,P=0.298).There was significant correlation between serum concentration of S1000 and the incidence of PVH-IVH on the third day after birth(OR 1.001,P = 0.047<0.05).There was no significant correlation between serum concentration of S100? on the first day and the seventh day after birth(OR = 0.999,P= 0.734;OR = 1.001,P = 0.625).The serum concentration of S100? in case group 1 was not higher than that in control group 1 on day 1 and 7 after birth,but higher on day 3 after birth.There was no significant difference in the serum concentration of S100? on day 1,3 and 7 after birth between the two groups(Z= 0.410,P = 0.681,Z ?-0.426,P = 0.670;Z=-0.377,P=0.706).There was no significant correlation between serum concentration of S100?and the incidence of PVH-IVH on the 1st,3rd and 7th day after birth(OR=1.00,P=0.703;OR=0.994,P=0.526;OR=1.004,P=0.474).Case group 2 and control group 2 were not compared because of the small number of cases.3.3 Serum S100? level in case groupSerum levels of S 100? M(P25,P75)were 182.42(100.05,260.44)pg/ml,107.15(100.00,161.31)pg/ml and 100.00(100.00,179.57)pg/ml,respectively,on the first day,the third day and the seventh day after birth in the case group.In the case group,there were 2 typical cases with obvious abnormal changes in serum S100? content.Case 1:The serum level of S100? decreased gradually on the first and third day after birth,but increased significantly on the seventh day(811.08pg/ml).The results of cranial ultrasound showed that no obvious intracranial hemorrhage was found on the 3rd day after birth,while PVH-IVH(grade ?)was found on the 7th day after birth.(2)Case 2:The serum level of S100? increased significantly on the 3rd day after birth(2732.29pg/ml),and then decreased gradually.The results of head color Doppler ultrasonography indicated that IVH(grade ?)occurred on the second day.4.ConclusionThe results showed that:1.There was no correlation between the serum level of S100? and the gestational age of normal early premature infants.,but it was negatively correlated with age.2.This study found that S100? increased significantly in some cases in the short term after PVH-IVH.3.The increase of S100? concentration in early preterm infants may be related to severe brain injury in late preterm infants.Because S100? has a short half-life and is invasive,it is not suitable for early clinical diagnosis of mild periventricular-intraventricular hemorrhage in premature infants. |
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