Risk factors of brain injury in very low birth weight infants / 临床儿科杂志

ABSTRACT

Objective To investigate the incidence and high risk factors of brain injury in very low birth weight infants(VLBWI),to reduce the morbidity of brain injury,and improve the developmental outcome of VLBWI. Methods Data of 181 VLBWI admitted in the neonatal intensive care unit(NICU)between October 2008 and September 2009 were retrospectively analyzed. The difference in basic information,maternity diseases,treatment and complication were analyzed between two groups(brain injury group and normal newborn group),and Logistic regression analysis was adopted to analyze the risk factors for brain injury. Results Seventy-eight of the 181 neonates(43.09%)were found to have brain injury,including 67 neonates(37.01% )with periventricular/intraventricular hemorrhage(43 with intraventricular hemorrhage(IVH)gradeⅠ,12 with IVH grade Ⅱ,10 with IVH grade Ⅲ,and 2 with IVH grade Ⅳ)and 12 neonates(6.63%,one complicated with IVH grade Ⅲ)with periventricular leukomalacia. The younger the gestational age,the higher the brain injury rate was observed. Concerning the brain injury rate,there were no differences in gender,single birth/plural births,birth weight,the mode of delivery,fetal distress,premature rupture of membrane,hypertension during pregnancy,placenta abruption,and intrauterine growth restriction(IUGR)between these two groups(P ＞ 0.05). The difference in therapeutic measures such as pulmonary surfactant therapy,nasal continuous positive airway pressure(nCPAP),conventional mechanical ventilation,and high-frequency oscillatory ventilation was significant(P ＜ 0.05),except aminophylline therapy(P ＞ 0.05). As to the complication,there were significant differences in the incidences of asphyxia,neonatal respiratory distress syndrome(NRDS),hypercapnia,metabolic acidosis,hyperglycemia,anemia,and personal digital assistant(PDA)(P < 0.05). However,there was no difference in the incidences of hypoglycemia,sepsis,thrombocytopenia,apnea,pulmonary hemorrhage,and hyperbilirubinemia between these two groups(P ＞ 0.05). Further Logistic regression analysis showed that NRDS,high-frequency oscillatory ventilation,and PDA were the main risk factors for brain injury in VLBWI. Conclusions VLBWI is the high-risk population of brain injury. Pulmonary surfactant therapy,nCPAP,conventional mechanical ventilation,high-frequency oscillatory ventilation,asphyxia,NRDS,hypercapnia,metabolic acidosis,hyperglycemia,anemia,and PDA were confirmed to be the high-risk factors for brain injury in VLBWI. And,NRDS,high-frequency oscillatory ventilation and PDA were main risk factors.