| ObjectiveBrain injury in preterm infants is mainly caused by many factors such as excessive blood flow fluctuation of brain vessels,limited self-regulation ability,inflammatory reaction,increase of oxygen free radicals,etc.As early clinical symptoms of brain injury in preterm infants are often atypical,they mostly rely on cranial color Doppler ultrasound,electroencephalogram,cranial MRI and other diagnostic aids.Neonatal head color Doppler ultrasound has been gradually applied to the diagnosis of intracranial hemorrhage and other diseases since the 1980s.Because of its advantages of simplicity,non-invasive,flexible operation and good specificity,it has been widely used in clinical practice and can dynamically monitor the hemodynamic changes of neonatal head blood vessels.Brain-derived neurotrophic factor(BDNF)is a member of the important neurotrophic factor family in the nervous system.BDNF can induce the directional differentiation of neural precursor cells,promote the maturation and perfection of the nervous system,and play an important role in the survival of neurons and the maintenance of normal physiological functions.Myelin basic protein(MBP),as an important component protein of nerve myelin,is highly specific to the nervous system,stabilizing and maintaining the structure and function of myelin sheath.Probiotics refers to the administration of a certain number of living microorganisms that can produce beneficial effects on the health of the host.At present,probiotics are mainly used in clinical treatment of neonatal feeding intolerance,hyperbilirubinemia,necrotizing enterocolitis,etc.However,some studies have shown that probiotics can also exert the bidirectional regulation of digestion and nervous system through microorganism-intestine-brain axis,promote the acceleration of nutrition intake,immune regulation,oxygen free radical scavenging,etc,thus exerting neuroprotective effect.The purpose of this data is to explore the clinical application value of probiotics in preventing brain injury in premature infants by studying the effects of probiotics on cerebral hemodynamics,plasma brain-derived neurotrophic factor and myelin basic protein levels in premature infants,so as to provide new early intervention methods for reducing the occurrence of brain injury in premature infants.Methods1.Research subjects 110 premature infants hospitalized in the neonatal ward of our hospital from March 2018 to March 2020 were selected as the research objects,and were divided into routine treatment group(54 cases)and probiotic prevention group(56 cases)according to the random number table method.2.Research methods Routine treatment group:to maintain water,electrolyte balance,normal blood sugar and supplement intravenous nutrition and other routine treatment;Probiotic prevention group:on the basis of conventional treatment group,probiotics were added for oral administration(nasal feeding).All premature infants improved the neonatal head color Doppler ultrasound examination on the 1st,7th and 14th days after birth,and observed the hemodynamic parameters of the middle cerebral artery(MCA),including systolic velocity(Vs),diastolic velocity(Vd)and resistance index(RI),which were reviewed every 2 weeks until discharge.Before discharge from the hospital or at the 40th week of corrected gestational age,the children were examined by magnetic resonance imaging(MRI).At the same time,2ml venous blood was collected from all premature infants on the 1st,7th and 14th days after birth,and the plasma brain-derived neurotrophic factor(BDNF)and myelin basic protein(MBP)levels were detected by enzyme-linked immunosorbent assay(ELISA).The changes of cerebral hemodynamic parameters(Vs,Vd,RI),BDNF,MBP at different time points between probiotic prevention group and routine treatment group were compared.Meanwhile,the relationship between cerebral hemodynamic parameters Vs,Vd,RI and BDNF,MBP was analyzed.The incidence of brain injury in premature infants was compared between the two groups3.Statistical treatment SPSS 22.0 statistical software was used for data statistical analysis.The measurement data were expressed by mean standard deviation(soil S).All continuous variables were first tested for normal distribution and variance homogeneity.Continuous variables are expressed by mean standard deviation(s),differences between groups are tested by Student's t,and comparisons within groups are tested by paired samples t.Counting data are expressed as percentages,and chi-square test is used for comparison between groups.Pearson correlation analysis was used to verify the correlation between indicators.It means statistically significant(P<0.05).Resuts1.There was no significant difference in gestational age,sex,birth weight and delivery mode between the two groups of premature infants(all P>0.05),which was comparable.2.The Vs,Vd and RI of MCA in two groups of premature infants increased with the increase of age.On the 1st and 7th day after birth,there was no significant difference in hemodynamic parameters(Vs,Vd,RI)between the two groups of premature infants(P>0.05).On the 14th day after birth,the Vs in probiotic prevention group was slightly higher than that in conventional treatment group,but the difference was not statistically significant(P=0.086),while Vd was significantly higher than that in conventional treatment group,the difference was statistically significant(P<0.05),and RI was significantly lower than that in conventional treatment group,the difference was statistically significant(P<0.05).Compared with the 7th day and the 1st day after birth,Vs,Vd and RI of premature infants in probiotic prevention group and conventional treatment group were significantly increased respectively,and the difference was statistically significant(P<0.05).Compared with the 14th and 7th days after birth,Vs and Vd in probiotic prevention group increased significantly,with statistical significance(P<0.05),but RI did not change significantly(P>0.05).Vs and RI in conventional treatment group were significantly increased,with statistically significant difference(P<0.05),while Vd had no significant change(P>0.05).3.On the 1st,7th and 14th day after birth,the plasma BDNF of the two groups of premature infants were compared at different corresponding time points,and there was no significant difference on the 1st and 7th day after birth(P>0.05).BDNF in probiotic prevention group was lower than that in conventional treatment group on the 14th day after birth,and the difference was statistically significant(P=0.041).Compared with the 7th day and the 1st day after birth,the plasma BDNF of the two groups of premature infants increased,and the difference was statistically significant(P<0.05).Compared with the 14th day and the 7th day after birth,the plasma BDNF levels of the two groups decreased significantly,and the difference was statistically significant(P<0.05).4.On the 1st,7th and 14th days after birth,the plasma MBP levels of the two groups of premature infants were compared at different corresponding time points,and there was no significant difference on the 1st and 7th days after birth(P>0.05).MBP in probiotic prevention group was lower than that in conventional treatment group on 14th day after birth,and the difference was statistically significant(P=0.017);Compared with the 7th day and the 1st day after birth,the plasma MBP level of the two groups of premature infants increased,with statistically significant difference(P<0.05).Compared with the 14th and 7th days after birth,MBP in plasma of probiotic prevention group decreased significantly,and the difference was statistically significant(P=0.000);There was no significant decrease in plasma MBP in conventional treatment group,and the difference was not statistically significant(P=0.495).5.RI of middle cerebral artery(MCA)had positive correlation with BDNF and MBP respectively(correlation coefficients r=0.773 and 0.755,P<0.01),but Vs and Vd had no linear relationship with BDNF and MBP respectively(P>0.05).6.Through head color Doppler ultrasound or head MRI,it was found that in 54 cases of conventional treatment group,18 cases(33.33%)had brain injury in premature infants.There were 12 cases(21.43%)of brain injury in premature infants in 56 of probiotic prevention group,but there was no significant difference between the two groups(x2=1.964,P=0.161).Conclusions1.The Vs and Vd of MCA in the two groups of premature infants increased with the increase of age,suggesting that with the gradual maturation of premature infants' brain,brain tissue metabolism increased,cerebrovascular blood flow velocity increased rapidly,and cerebral blood flow perfusion increased.2.Conventional treatment and probiotic prophylaxis have certain effects on improving cerebral blood perfusion in premature infants,but probiotic prophylaxis is superior to conventional treatment alone in improving vascular resistance.3.Plasma BDNF and MBP showed an increasing trend after brain injury in preterm infants.After intervention with probiotics,plasma BDNF and MBP decreased significantly.This shows that probiotic prevention can more effectively promote the functional recovery of brain cells.4.The hemodynamic parameters RI of MCA are positively correlated with plasma BDNF and MBP after brain injury in preterm infants,which further indicates that cerebral blood flow parameters,BDNF and MBP can reflect brain injury in preterm infants and have good consistency.5.The incidence of brain injury in preterm infants in this study is 27.27%,of which the incidence of brain injury in probiotic prevention group(21.43%)is lower than that in conventional treatment group(33.33%),suggesting that the occurrence and clinical outcome of brain injury in preterm infants may be improved to some extent by strengthening the nutritional supply of nerve cells,immune support,scavenging oxygen free radicals and excitatory amino acids,and microorganism-intestine-brain axis pathway to improve the blood supply of brain tissue and achieve the function of nerve cell repair. |
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