ABSTRACT
Objective To study the correlation between histological chorioamnionitis (HCA),prenatal corticosteroids and early brain injury of preterm infants.Method From December 2014 to December 2016,preterm infants with gestational age ≤ 34 weeks admitted to our hospital and umbilical cord blood samples taken immediately after birth were reviewed.According to the results of pathological examination of their mother's placenta and the use of glucocorticoids (GCs),they were assigned into HCA+ GCs + group,HCA + GCs-group,HCA-GCs-group,and HCA-GCs +group.The levels of lnterleukin-6 (IL-6),hepcidin,erythropoietin (EPO),human activin A (ACV-A),S-100β protein,and CC-chemokine ligand 18 (CCL18) in premature infants' umbilical cord blood in each group were tested using ELISA method.The incidences of premature infants' early brain injury and the correlation with inflammatory factors in each group were analyzed.The ROC curve was used to analyze the sensitivity and specificity of S-100β protein and IL-6 level in predicting early brain injury in preterm infants with placenta inflammation.Result A total of 343 infants with gestational age ≤ 34 weeks and their umbilical cord blood samples were tested.Among the 343 premature infants,47.1％ suffered from early brain injury (98/208) in the HCA+ group;while 27.4％ suffered from early brain injury (37/135) in the HCA-group,the difference was statistically significant between the two groups (P ＜ 0.001).A total of 142 cases received prenatal GCs treatment,and 41 (28.9％) cases had early brain injury.201 cases didn't receive prenatal GCs treatment,and 94 (46.8％) had early brain injury.The differences between the two groups were also statistically significant (P=0.001).The incidence of early brain injury in the HCA+GCs-group was significantly higher than the HCA+GCs+ group,HCA-GCs-group and HCA-GCs+ group(P＜0.05).The S-100β protein and IL-6 level in umbilical cord blood of the HCA+GCs-group and HCA+GCs+ group were higher than the HCA-GCs-group(P＜0.05).The area under the ROC curve for IL-6 predicting early brain injury in preterm infants was 0.732 (95％CI 0.675～0.789,P＜0.05).The cut-off value of 213.45 pg/ml of IL-6 (was selected to predict the risk of early brain injury with the sensitivity of 41.9 ％ and the specificity 99.0 ％.The area under the ROC curve for S-100β protein was 0.511 (95％CI 0.449～0.574,P=0.723).Conclusion Placental inflammation and insufficient prenatal glucocorticoids treatment are closely related to the occurrence of early brain injury in preterm infants.S-100β protein and IL-6 in umbilical cord blood may play an important role in early brain injury of premature infants.The IL-6 level has a higher predictive value for early brain injury,while S-100β protein level has a less predictive value.
ABSTRACT
Objective To analyze the risk factors for the failure of the intubate-surfactant-extubate to continuous positive airway pressure (INSURE) strategy in preterm infants with respiratory distress syndrome (RDS).Methods Premature infants with gestation age ＜ 34 weeks and hospitalized between August 2016 and November 2018 in Department of Neonatology,Xiamen Maternal and Child Health Hospital were eligible for this descriptive study,and were classified into 2 groups:INSURE success group (281 cases),and INSURE failure group (70 cases),according to whether the infants need to be re-intubated and have invasive ventilator therapy within 72 hours after birth.The clinic information of premature infants in different groups were analyzed.Results The failure rate of INSURE strategy was 19.9％ (70/35I cases).Compared with the success group,the premature infants in failure group had smaller gestational age [31.9 (30.0,32.6) weeks] and lower 1 minute Apgar score (8.0 ± 1.9) scores (Z =10.533,t =2.354,all P ＜0.05).The incidence of male infants (74.3％),patent ductus arteriosus (PDA) (12.9％ without PDA,26.8％ ＜0.25 cm,28.3％ ≥ 0.25 cm) and maternal placental abruption was higher (21.4％),and radiological grade (grade 1 was 2.5％,grade 2 was 16.1％,grade 3 was 30.3％,and grade 4 was 66.7％) was more severe (x2 =41.169,P ＜ 0.05).The use rate of antepartum glucocorticoid (28.3 ％ without use,24.9％ for partial treatment and 14.4％ for full treatment) was lower (x2 =7.315,P ＜ 0.05).Logistic regression analysis showed that no use of antepartum glucocorticoid (OR =0.634,95％ CI:0.423-0.951,P =0.027),placental abruption (OR =2.203,95％ CI:1.024-4.738,P =0.043),male infants (OR =2.475,95 ％ CI:1.259-4.867,P =0.009),low gestational age (OR =0.835,95％ CI:0.707-0.986,P =0.033),severe radiological grade (OR =2.829,95 ％ CI:1.886-4.245,P =0.000),and PDA (OR =1.550,95 ％ CI:1.040-2.311,P =0.032) were the risk factors for INSURE failure.Conclusions Placental abruption,male infants,lower gestational age,severe RDS grading,and PDA are risk factors for the failure of the INSURE strategy in preterm infants with respiratory distress syndrome.Antepartum glucocorticoid treatment can improve success rate of INSURE treatment.
ABSTRACT
Objective@#To analyze the risk factors for the failure of the intubate-surfactant-extubate to continuous positive airway pressure(INSURE) strategy in preterm infants with respiratory distress syndrome(RDS).@*Methods@#Premature infants with gestation age<34 weeks and hospitalized between August 2016 and November 2018 in Department of Neonatology, Xiamen Maternal and Child Health Hospital were eligible for this descriptive study, and were classified into 2 groups: INSURE success group (281 cases), and INSURE failure group(70 cases), according to whether the infants need to be re-intubated and have invasive ventilator therapy within 72 hours after birth.The clinic information of premature infants in different groups were analyzed.@*Results@#The failure rate of INSURE strategy was 19.9%(70/35I cases). Compared with the success group, the premature infants in failure group had smaller gestational age[31.9(30.0, 32.6)weeks] and lower 1 minute Apgar score(8.0±1.9) scores (Z=10.533, t=2.354, all P<0.05). The incidence of male infants (74.3%), patent ductus arteriosus(PDA) (12.9% without PDA, 26.8% <0.25 cm, 28.3% ≥0.25 cm) and maternal placental abruption was higher (21.4%), and radiological grade (grade 1 was 2.5%, grade 2 was 16.1%, grade 3 was 30.3%, and grade 4 was 66.7%) was more severe (χ2=41.169, P<0.05). The use rate of antepartum glucocorticoid (28.3% without use, 24.9% for partial treatment and 14.4% for full treatment) was lower (χ2=7.315, P<0.05). Logistic regression analysis showed that no use of antepartum glucocorticoid(OR=0.634, 95%CI: 0.423-0.951, P=0.027), placental abruption(OR=2.203, 95%CI: 1.024-4.738, P=0.043), male infants(OR=2.475, 95%CI: 1.259-4.867, P=0.009), low gestational age(OR=0.835, 95%CI: 0.707-0.986, P=0.033), severe radiological grade(OR=2.829, 95%CI: 1.886-4.245, P=0.000), and PDA(OR=1.550, 95%CI: 1.040-2.311, P=0.032)were the risk factors for INSURE failure.@*Conclusions@#Placental abruption, male infants, lower gestational age, severe RDS grading, and PDA are risk factors for the failure of the INSURE strategy in preterm infants with respiratory distress syndrome.Antepartum glucocorticoid treatment can improve success rate of INSURE treatment.
ABSTRACT
In recent years, with the increase of elective cesarean section rate and other factors,the rate of neonatal respiratory distress in full-term neonates is rising,which has aroused widespread concern.The risk factors and related mechanisms of respiratory distress syndrome in full-term infants were reviewed from two aspects of maternal and infant.Selective cesarean section, gestational age, fetal sex and some pregnancy complications can affect the rate of respiratory distress syndrome in full-term infants.Timely use of respiratory support and early use of pulmonary surfactant, and the combined use of comprehensive measures can reduce the mortality of neonatal respiratory distress syndrome rate.