Clinical Analysis Of The High Risk Factors Of Neonatal Hypoxic Ischemic Encephalopathy

ObjectiveBased on the analysis of antenatal,intrapartum and postpartum easily lead to all kinds of hypoxia in children suffering of neonatal hypoxic-ischemic encephalopathy to investigate the major factor of neonatal hypoxic-ischemic encephalopathy.Compared with the normal newborns,further studys have been done with the neonatal hypoxic-ischemic encephalopathy in genetic.Analyze the gene polymorphism of Apo E in HIE newborns to explore the relationship between the gene polymorphism of Apo E and the neonatal HIE to seek the neonatal HIE genetic susceptibility genes.Explain the mechanism of HIE in gene levels and provide a new theoretical in prevention,diagnosis and treatment,and prognosis.Methods1.Analyzed the various of risk factors of prenatal,intrapartum and postpartum(maternal pregnancy-induced hypertension,maternal anemia,cord entanglement,amniotic fluid turbidity,neonatal asphyxia and so on)about 151 HIE newborns in Taishan Medical College Hospital neonatal intensive care unit(NICU),compared with 145 healthy newborns born in the same time.Using chi-square test,P <0.05 was considered significant statistically.2.Selected 113 normal newborns with their unpolluted cord blood and 130 diagnosed HIE newborns taking their venous blood,extracted their apolipoprotein E,compared the study of apolipoprotein E genotype results,to investigate the differences between groups of apolipoprotein E genotype and the clinical significance.Count data using the number of cases and percentages between the two groups were compared using chi-square test;P<0.05 were considered as statistically significant.Groups were compared using chisquare test,P<0.05 were considered as significant statistically.Results1.The statistical analysis of 151 cases of neonatal hypoxic-ischemic brain in children and 145 cases of normal newborns born in the same period,showed that there were 93 ca-ses of neonatal asphyxia in group HIE,accounted for 61.6% of the total.Amniotic fluid contamination occurred in 35 cases,accounting for 23.2% of the total.The mother suffering from gestational hypertension were 35 cases,accounting for 23.2% of the total.The mother during pregnancy anemia HIE group of 29 cases,accounting for 19.2% of the total.There were 29 cases of maternal anemia during pregnancy in group HIE,accounting for 19.2% of the total.The result showed that neonatal asphyxia,amniotic fluid pollution,pregnancy induced hypertension have such a high proportion of neonatal HIE occurrence,were the important factors to cause the neonatal HIE.Compared with control group in single factor chi square test,the result showed that maternal gestational period hypertension(P<0.01),neonatal asphyxia(P<0.01),abnormal umbilical cord(P<0.01),amniotic fluid pollution(P=0.018),maternal anemia(P=0.023),placental abruption(P=0.021)were the risk factors of neonatal hypoxic ischemic encephalopathy(HIE).2.130 neonatal HIE and 113 normal newborns born in the same period,peripheral blood 2ml,ApoE gene was measured.The result showed that genotype E3/E3 were 87,E2/E3 were 14,E3/E4 were 8,E2/E4 were 3,E2/E2 was one,did not check out E4/ E4 genotype in 113 normal newborns.The frequency of E3 gene was 86.73%,E2 8.40%,E4 4.87%.After chi square test,the genotype frequency P > 0.05,which was in accordance with Hard-weinberg’s law.In 130 neonatal HIE,genotype E3/E3 were 81,E2/E3 were 12,E3/E4 were 24,E2/E4 were 8,E2/E2 was 1,E4/E4 was 4.And E3 gene frequency was 76.15%,E2 was 8.46%,E4 was 15.38%.After chi square test,the genotype frequency P > 0.05,which was in accordance with Hard-weinberg’s law.Data were analyzed,and the proportion of E3/E3 genotype in HIE group was less than that in control group(P<0.05,the difference was statistically significant).The proportion of E3/E4 genotype was more than that of the control group significantly(P<0.01,the difference was statistically significant).Chisquare test was carried out on the frequency of three alleles in two groups,and the proportion of E3 allele in HIE group was significantly lower than that in control group(P<0.05,the difference was statistically significant).The gene frequency of E4 in HIE was significantly higher than that in control group(P<0.05,and the difference was statistically significant).3.According to neonatal hypoxic ischemic encephalopathy clinical classification criteria in 130 neonatal HIE,there were 91 in mild,30 in moderate,9 in severe.Data were analyzed,line x column chi square test to the six gene phenotypes in the three groups of HIE children.The group data<1,so use the Fisher test method.The result P>0.05,which showed that the distribution of the six kinds of gene phenotype in the three groups of HIEwere no significant difference.Line x list chi square test to gene frequency of three alleles in the three groups of HIE children.The result P>0.05,which showed that the gene frequency of three alleles in the three groups of HIE children were no significant difference.Conclusion1.Proved that the maternal gestational hypertension,neonatal asphyxia,umbilical cord abnormality,amniotic fluid pollution,maternal anemia and placental abruption were the high risk factors of neonatal hypoxic ischemic encephalopathy.And the more risk factors,the more prone to the occurrence of neonatal HIE,that is,the greater probability of occurrence of neonatal HIE.In addition,the cause of neonatal HIE is still need to be further investigated.In order to reduce the incidence of neonatal HIE,we should search for the inherent and intrinsic causes actively.2.The distribution of ApoE gene phenotype in HIE and normal newborns is different.The number of E3/E3 genotype in HIE children was lower than that of normal newborns and the number ofE3/E4 genotype in HIE children was higher than that of normal newborns.And E3 allele frequency in HIE children was lesser than that of normal newborns,E4 allele frequency in HIE children was higher than that of normal newborns.Thus,the distribution of E3 and E4 alleles in HIE and normal newborns were different.E3 allele has a protective effect on newborns.E4 allele was closely related to the occurrence of HIE.It is easily to occur neonatalhypoxic ischemic encephalopathy with carrying E4 allele.3.The composite ratio of the six genes of ApoE in the light of the three groups of patients with mild to severe HIE have no statistical difference.Compared with the frequency of the three alleles in the three groups of neonatal HIE,the result has no statistical difference.The genetic polymorphism of ApoE was not related to the severity of neonatal HIE.