A preliminary study on diagnosis and grading of hypoxic-ischemic brain damage of premature infants / 中国当代儿科杂志

ABSTRACT

<p><b>OBJECTIVE</b>Hypoxic-ischemic brain damage (HIBD) occurs frequently in premature infants, resulting death or neurological sequela in some survivors. Up to now, however, there are no diagnostic criteria for this disease. The aim of this study was to explore the diagnostic criteria and the grading principle for HIBD of premature infants.</p><p><b>METHODS</b>The clinical data of 453 premature infants who were diagnosed with HIBD based on the diagnostic criteria for HIBD of term infants, including medical history, clinical manifestations, laboratory results and imaging findings, were studied retrospectively.</p><p><b>RESULTS</b>A preliminary diagnostic criteria for HIBD of premature infants was propounded based on clinical and pathologic features of brain damage of premature infants. Of the 453 premature infants, 346 (76%) matched the diagnostic criteria. Of the 346 cases, PaO2 (42.21 +/- 8.33 mmHg) and /or SaO2 (68.49 +/- 5.19%) decreased in 208 patients and the BE value (-10.86 +/-3.41 mmol/L) decreased in 138 patients. The sensitivity and specificity of cranial computer tomography for the diagnosis of HIBD in premature infants was 100% and 17.8%, respectively. Cranial ultrasound displayed a sensitivity of 87.9% and specificity of 100% for the diagnosis of HIBD in premature infants.</p><p><b>CONCLUSIONS</b>The diagnostic criteria used for HIBD for term infants is not suitable for premature infants. This study puts forward the reference diagnostic criteria of premature HIBD as following 1) evidence of hypoxia; 2) neurological symptoms and signs; 3) imaging findings: severe brain edema, germinal matrix intraventricular hemorrhage (GMH-IVH), periventricular leukomalacia (PVL), or brain infarction, and/or the resistance index (RI) > 0.75 or < 0.55 showed by cranial ultrasound; 4) Brain damage caused by infection, electrolyte disturbance and congenital metabolic disease was excluded. The grading principle of premature HIBD is proposed as follows MILD HIBD when cranial ultrasound shows grade I-II of GMH-IVH or PVL, and SEVERE HIBD when cranial ultrasound shows grade III-IV of GMH-IVH or PVL.</p>