Clinical Analysis Of Periventricular-intraventricular Hemorrhage In Preterm Infants

ObjectiveAnalyzed the clinical data in 309 preterm infants cases of periventricular-intraventricular hemorrhage,to explore the common hign risk factors and treatment effect of serial lumbar puncture in severe PIVH preterm infants,to assess the impact of neurodevelopment in preterm infants,provide theoretical reference for improving the clinical diagnosis and treatment level of PIVH.MethodThe clinical data of preterm infants diagnosed as PIVH in the First Affiliated Hospital of Guangxi Medical University from January 2016 to December 2018,used the retrospective analysis method.According to Papile classification,defined as PIVH I,II,III and IV,PIVH I～II being mild and III～IV being severe.Used statistical software SPSS23 to analyzethe general data ofsex,gestational age,birth weight,mode of delivery(spontaneous delivery/cesarean section),fetus distress and birth asphyxia,apgar score,hospitalization days,umbilical cord condition(including neck wrap,true nodule and prolapse),maternalfactors(previouspregnancy≥1,multifetus,pregnancy hypertensive syndrome,diabetes,prelabor rupture of the membrane≥12 h,antenatal corticosteroid use),analyzed hign risk factors that may lead to severe PIVH by single factor and multi factor logistic regression analysis;the clinical data of LP therapy were analyzed by Fisher’s exact probability value to judge the efficacy of LP therapy,with a statistical significance of P < 0.05.Results1.The incidence of PIVH was 25.02%(309/1235),the incidences of PIVH with grade I,grade II,grade III were 36.89%(114/309),55.34%(171/309)and 7.77%(24/309).2.The lower the gestational age and birth weight was,the lower the Apgar score,the longer the hospitalization days,the higher the incidence rate of PIVH was.3.Respiratory distress syndrome is associated with severe PIVH,and antenatal corticosteroid use within 1 week before birth is associated with severe PIVH reduction.4.Treatment of severe PIVH with serial LP,the total effective rate of LP therapy was 78.57%(10/14),the poor prognosis rate of periventricular leukomalacia was 7.14%(1/14)and 7.14%(1/14)for hydrocephalus.The CSF cell count,protein content and lateral ventricle measurements were significantly decreased before and after serial LP therapy(P<0.05).5.The GDDS of PIVH preterm infants after discharge was evaluated.The preterm infants in grade III was after LP therapy,and verbal ability of grade III were lower than those of grades I-II,but there was no statistical significance in the other four functional zones and the comparison in corrected age of 1,6,18 and 24 months(P>0.05),after LP therapy,PIVH III preterm infants had no significant mental retardation except for a little backward in verbal ability;the development of other functional zones was normal ingrades I to II except for the low score of big sports ability in 12 months in corrected age,and all energy areas was normal of grade III in corrected age of 24 months.6.13 cases of severe PIVH preterm infants were treated with serial LP,1case defined as cerebral palsy(7.69%),was assessed as neurodevelopmental disability,4 cases defined as of motor development retardation(30.77%)and 11 cases normal.Conclusion1.Gestational age,birth weight,birth score,days of hospitalization,use of ventilator ventilation within 1 week after birth,infection,respiratory distress syndrome,first blood gas analysis BE value <-5 mmol/L,abnormal coagulation function,perinatal asphyxia were all associated with increased the risk of PIVH.2.Respiratory distress syndrome was an important hign risk factor for severe PIVH,and antenatal corticosteroid usefor 1 week before delivery was a protective factor.3.The prognosis of grade PIVH I～II is good,most of the prognosis of grade III is good after serial LP.4.Serial lumbar puncture therapy could effectively treat high-grade PIVH,to reduce the occurrence of hydrocephaly and poor prognosis.