Application Value Of Near-infrared Spectroscopy In Neonatal Intracranial Hemorrhage

ObjectivePeriventricular-intraventricular hemorrhage（PIVH）is a common complication of preterm infants.In severe cases,it can lead to death or neurological sequelae.It is still a clinically gordian knot.Near-infrared spectroscopy technology（NIRS）is a brain function monitor that has developed rapidly in recent years and has broad application prospects.This study compared the rcSO₂and FTOE between preterm infants without brain injury and with PIVH,exploring the cerebral oxygen metabolism characteristics of premature infants with PIVH and explaining its pathophysiological characteristics.By studying the correlation analysis of the rcSO₂and amplitude-integrated electroencephalogram（a EEG）,brainstem auditory evoked potentials（BAEP）in preterm infants,explore the value of near-infrared spectroscopy in assessing the damage of nervous system function.It is hoped to provide new methods for the clinical management of premature infants.MethodsFrom January 2020 to January 2021,A prospective and observational study was conducted on 487 preterm infants with gestational age≤34 weeks and age≤3 days after birth who were hospitalized in the Department of Neonatology（including NICU）of Guangzhou Women and Children’s Medical Center.Exclusion criteria:（1）Preterm infants with a history of severe asphyxia,hypoxic ischemic encephalopathy,bilirubin encephalopathy,epilepsy,etc.（2）Preterm infants with obvious malformations such as complex congenital heart disease,inherited metabolic diseases,genetic or chromosomal abnormalities;（3）Obvious damage to the forehead skin.All included subjects were examined head ultrasound and NIRS within 24 hours after admission.All subjects were divided into control group,mild PIVH group,and severe PIVH group according to the results of head ultrasound.A total of 366 cases were included,189 cases,138 cases,and 39 cases,respectively.The preterm infants who included in PIVH group were examined a EEG and BAEP within 72 hours.According to the three factors of gestational age,weight and PDA,the matching between groups was performed.Finally a total of 32 pairs were matched,with 32 cases in each group.（1）Analysis the basic situation of the control group,mild PIVH group,and severe PIVH group.（2）Analyze the difference of rcSO₂and FTOE between the control group,mild PIVH group,and severe PIVH group.（3）Analyze the correlation between the rcSO₂and a EEG graph maturity score and BAEP abnormal degree.Result1.Basic situation between the three groupsBefore matching,there was no statistical difference between three groups in the proportion of males,the proportion of normal delivery,Apgar score at 5 minutes after birth,the proportion of mothers suffering from pregnancy-induced hypertension,PH and Pa O₂.There were statistical differences in gestational age,birth weight,the proportion of combined PDA and Pa CO₂（P=0.002;P<0.001;P=0.043;P=0.039）.After matching,there was no statistical difference in the proportion of males,gestational age,birth weight,Apgar score at 5 minutes after birth,proportion of normal delivery,maternal hypertension during pregnancy,and proportion of combined PDA.2.Differences in rcSO₂and FTOE between three groupsBefore matching,the rcSO₂of the control group was（64.23±9.78）%and the FTOE was（0.35±0.10）;the rcSO₂of the mild PIVH group was（60.72±9.21）%,and the FTOE was（0.39±0.09）;the rcSO₂of the severe PIVH group was（54.87±7.50）and FTOE is（0.44±0.08）.The differences of rcSO₂and FTOE among the three groups were statistically significant（H=33.19 P<0.001;H=35.17 P<0.001）.The rcSO₂and FTOE of the severe PIVH group were statistically different from those of the control group（adjusted P<0.001;adjusted P<0.001）;the rcSO₂and FTOE of the severe PIVH group were statistically different from those of the mild PIVH group（adjusted P<0.001;adjusted P<0.001）;the rcSO₂and FTOE of the mild PIVH group were statistically different from the rcSO₂and FTOE of the control group（adjusted P=0.022;adjusted P=0.012）.After matching,the rcSO₂of the control group was（63.06±6.04）%,FTOE was（0.36±0.06）;the rcSO₂of the mild PIVH group was（59.41±5.98）%,and the FTOE was（0.40±0.07）;the rcSO₂of the severe PIVH group was（55.28±7.86）and the FTOE was（0.44±0.08）.The differences of rcSO₂and FTOE among the three groups were statistically significant（F=10.90 P<0.001;F=9.88 P<0.001）.The rcSO₂and FTOE of the severe PIVH group were statistically different from those of the control group（P<0.001;P<0.001）;the rcSO₂of the severe PIVH group was statistically different from that of the mild PIVH group（P=0.046）,but there was no statistical difference about FTOE（P=0.051）;there was no statistical difference between the mild PIVH group and the control group in rcSO₂and FTOE（P=0.093;P=0.142）.3.The correlation between the rcSO₂and a EEG graph maturity score and BAEP abnormal degreeThe rcSO₂was positively correlated with a EEG maturity score with moderate strength（r=0.437 P=0.001）.The rcSO₂value was negatively correlated with the BAEP abnormality score of low intensity r=-0.266 P=0.034).Conclusion1.Low gestational age,low birth weight,PDA and hypercapnic are high-risk factors for PIVH in preterm infants.Clinical monitoring and early prevention should be performed for this neonate.2.The rcSO₂ of preterm infants with severe PIVH is significantly lower than that of preterm infants with normal and mild PIVH.NIRS has a certain value in identifying PIVH in preterm infants,especially in the identification of severe grade III-IV hemorrhage.3.There is a correlation between rcSO₂in preterm infants with PIVH and a EEG pattern maturity and BAEP abnormality.Near-infrared spectroscopy technology has a potential value in identifying the degree of brain damage,and it is expected to become a supplementary method for traditional brain function monitoring in NICU in the future.