Extremely preterm infants born outside a provincial tertiary perinatal center and transferred postnatally associated with poor outcomes: a real-world observational study.

Introduction: Extremely preterm infants (EPIs) have high morbidity and mortality, and are recommended to be born in a tertiary perinatal center (inborn). However, many EPIs in central China are born in lower-level hospitals and transferred postnatally, the outcomes of which remain to be investigated. Methods: EPIs admitted to the Department of Neonatology, Maternal and Child Health Hospital of Hubei Province from January 2013 to December 2022 were retrospectively recruited and divided into the control (inborn) and transfer groups (born in other hospitals). The neonatal and maternal characteristics, neonatal outcomes, and the treatment of survival EPIs were analyzed. Results: A total of 174 and 109 EPIs were recruited in the control and transfer groups, respectively. EPIs in the transfer group have a higher birth weight and a lower proportion of multiple pregnancies than the control group (all P < 0.05). The proportions of antenatal steroids, magnesium sulfate, cesarean delivery, premature rupture of membranes ≥18 h, gestational diabetes, and amniotic fluid abnormalities were lower in the transfer group (all P < 0.05). Survival rates (64.22% vs. 56.32%), proportions of severe periventricular-intraventricular hemorrhage (PIVH) (11.93% vs. 11.49%), severe bronchopulmonary dysplasia (sBPD) (21.05% vs. 20%), and severe retinopathy of prematurity (ROP) (24.77% vs. 20.11%) were similar in the transfer and control groups (all P > 0.05). However, the transfer group had higher proportions of severe birth asphyxia (34.86% vs. 13.22%, P < 0.001), PIVH (42.20% vs. 29.89%, P = 0.034), and extrauterine growth retardation (EUGR) (17.43% vs. 6.32%, P = 0.003). Less surfactant utilization was found in the transfer group among survival EPIs (70.00% vs. 93.88%, P < 0.001). Conclusion: EPIs born outside a tertiary perinatal center and transferred postnatally did not have significantly higher mortality and rates of severe complications (severe PIVH, severe ROP, and sBPD), but there may be an increased risk of severe asphyxia, PIVH and EUGR. This may be due to differences in maternal and neonatal characteristics and management. Further follow-up is needed to compare neurodevelopmental outcomes, and it is recommended to transfer the EPIs in utero to reduce the risk of poor physical and neurological development.

Nonhematopoietic Umbilical Cord Blood Stem Cell Administration Improves Long-term Neurodevelopment After Periventricular-Intraventricular Hemorrhage in Neonatal Rats.

Periventricular-intraventricular hemorrhage (PIVH) is common in extremely low gestational age neonates (ELGAN) and leads to motor and behavioral impairments. Currently there is no effective treatment for PIVH. Whether human nonhematopoietic umbilical cord blood-derived stem cell (nh-UCBSC) administration reduces the severity of brain injury and improves long-term motor and behavioral function was tested in an ELGAN-equivalent neonatal rat model of PIVH. In a collagenase-induced unilateral PIVH on postnatal day (P) 2 model, rat pups received a single dose of nh-UCBSCs at a dose of 1 × 106 cells i.p. on P6 (PIVH + UCBSC group) or were left untreated (Untreated PIVH group). Motor deficit was determined using forelimb placement, edge-push, and elevated body swing tests at 2 months (N = 5-8). Behavior was evaluated using open field exploration and rearing tests at 4 months (N =10-12). Cavity volume and hemispheric volume loss on the PIVH side were determined at 7 months (N = 6-7). Outcomes were compared between the Untreated PIVH and PIVH + UCBSC groups and a Control group. Unilateral motor deficits were present in 60%-100% of rats in the Untreated PIVH group and 12.5% rats in the PIVH + UCBSC group (P = 0.02). Untreated PIVH group exhibited a higher number of quadrant crossings in open field exploration, indicating low emotionality and poor habituation, and had a cavitary lesion and hemispheric volume loss on the PIVH side. Performance in open field exploration correlated with cavity volume (r2 = 0.25; P < 0.05). Compared with the Untreated PIVH group, performance in open field exploration was better (P = 0.0025) and hemispheric volume loss was lower (19.9 ± 4.4% vs 6.1 ± 2.6%, P = 0.018) in the PIVH + UCBSC group. These results suggest that a single dose of nh-UCBSCs administered in the subacute period after PIVH reduces the severity of injury and improves neurodevelopment in neonatal rats.

Risk factors of periventricular-intraventricular hemorrhage in premature infants / 中国小儿急救医学

Objective:To analyze the potential risk factors of periventricular-intraventricular hemorrhage(PIVH)in premature infants.Methods:A retrospective study was conducted on clinical data of 279 premature infants admitted to the Affiliated Hospital of Guizhou Medical University From January 1, 2019 to December 31, 2019, who completed cranial ultrasound during hospitalization.According to the cranial ultrasound with or without PIVH, the cases were divided into PIVH group and non-PIVH group.The premature infants with PIVH were divided into severe PIVH(grade Ⅲ and Ⅳ)group and mild PIVH(grade Ⅰand Ⅱ)group according to the PIVH grades.A total of 25 factors, which may influnce PIVH, were analyzed by univariate analysis, and then multivariate Logistic stepwise regression analysis(stepwise backwards method)was performed to determine the major risk factors.Results:(1)A total of 279 premature infants were included in the study, 133 of them in PIVH group, and 146 of them in non-PIVH group.Univariate analysis showed that there were statistically significant differences in 14 factors between two groups, including full treatment of antenatal steroid, gestation age, birth weight, neonatal asphyxia, hypothermia, early onset sepsis, metabolic acidosis, hypernatremia, anemia, respiratory distress syndrome, noninvasive ventilation, invasive ventilation, invasive ventilation within 72 hours after birth, and lumbar puncture within 72 hours after birth( P<0.05). Multivariate analysis showed that gestational age( OR=0.709, 95% CI 0.602-0.835), and full treatment of antenatal steroid( OR=0.354, 95% CI 0.189-0.664) were protective factors for PIVH in premature infants, while neonatal asphyxia( OR=2.425, 95% CI 1.171-5.023), hypothermia( OR=2.097, 95% CI 1.088~4.041), early onset sepsis( OR=12.898, 95% CI 1.433-115.264), metabolic acidosis( OR=2.493, 95% CI 1.398-4.442), invasive ventilation within 72 hours after birth( OR=5.408, 95% CI 1.156-25.297), lumbar puncture within 72 hours after birth ( OR=5.035, 95% CI 1.269-19.993) were independent risk factors for PIVH in premature infants( P<0.05). (2) Among 133 cases of premature PIVH, 20 cases were severe PIVH and 13 cases were mild PIVH.Univariate analysis showed that there were statistically significant differences in 5 factors between two groups, including antenatal magnesium sulfate, gestation age, early onset sepsis, abnormal coagulation, and lumbar puncture within 72 hours after birth.Multivariate analysis showed that early onset sepsis( OR=4.392, 95% CI 1.343-14.367) and abnormal coagulation( OR=3.502, 95% CI 1.234-9.867) were independent risk factors for severe PIVH in premature infants( P<0.05). Conclusion:Gestational age is negatively correlated with the occurrence of PIVH in premature infants, and completion of more than a course of treatment for antenatal dexamethasone is an independent protective factor of PIVH in premature infants.Neonatal asphyxia, metabolic acidosis, hypothermia(<35 ℃), early onset sepsis, invasive ventilation within 72 hours after birth, and lumbar puncture within 72 hours after birth are independent risk factors for PIVH in premature infants.Abnormal coagulation and early onset sepsis are independent risk factors for severe PIVH in premature infants.

Risk factors of periventricular-intraventricular hemorrhage in premature infants / 中国小儿急救医学

Objective:To analyze the potential risk factors of periventricular-intraventricular hemorrhage(PIVH)in premature infants.Methods:A retrospective study was conducted on clinical data of 279 premature infants admitted to the Affiliated Hospital of Guizhou Medical University From January 1, 2019 to December 31, 2019, who completed cranial ultrasound during hospitalization.According to the cranial ultrasound with or without PIVH, the cases were divided into PIVH group and non-PIVH group.The premature infants with PIVH were divided into severe PIVH(grade Ⅲ and Ⅳ)group and mild PIVH(grade Ⅰand Ⅱ)group according to the PIVH grades.A total of 25 factors, which may influnce PIVH, were analyzed by univariate analysis, and then multivariate Logistic stepwise regression analysis(stepwise backwards method)was performed to determine the major risk factors.Results:(1)A total of 279 premature infants were included in the study, 133 of them in PIVH group, and 146 of them in non-PIVH group.Univariate analysis showed that there were statistically significant differences in 14 factors between two groups, including full treatment of antenatal steroid, gestation age, birth weight, neonatal asphyxia, hypothermia, early onset sepsis, metabolic acidosis, hypernatremia, anemia, respiratory distress syndrome, noninvasive ventilation, invasive ventilation, invasive ventilation within 72 hours after birth, and lumbar puncture within 72 hours after birth( P<0.05). Multivariate analysis showed that gestational age( OR=0.709, 95% CI 0.602-0.835), and full treatment of antenatal steroid( OR=0.354, 95% CI 0.189-0.664) were protective factors for PIVH in premature infants, while neonatal asphyxia( OR=2.425, 95% CI 1.171-5.023), hypothermia( OR=2.097, 95% CI 1.088~4.041), early onset sepsis( OR=12.898, 95% CI 1.433-115.264), metabolic acidosis( OR=2.493, 95% CI 1.398-4.442), invasive ventilation within 72 hours after birth( OR=5.408, 95% CI 1.156-25.297), lumbar puncture within 72 hours after birth ( OR=5.035, 95% CI 1.269-19.993) were independent risk factors for PIVH in premature infants( P<0.05). (2) Among 133 cases of premature PIVH, 20 cases were severe PIVH and 13 cases were mild PIVH.Univariate analysis showed that there were statistically significant differences in 5 factors between two groups, including antenatal magnesium sulfate, gestation age, early onset sepsis, abnormal coagulation, and lumbar puncture within 72 hours after birth.Multivariate analysis showed that early onset sepsis( OR=4.392, 95% CI 1.343-14.367) and abnormal coagulation( OR=3.502, 95% CI 1.234-9.867) were independent risk factors for severe PIVH in premature infants( P<0.05). Conclusion:Gestational age is negatively correlated with the occurrence of PIVH in premature infants, and completion of more than a course of treatment for antenatal dexamethasone is an independent protective factor of PIVH in premature infants.Neonatal asphyxia, metabolic acidosis, hypothermia(<35 ℃), early onset sepsis, invasive ventilation within 72 hours after birth, and lumbar puncture within 72 hours after birth are independent risk factors for PIVH in premature infants.Abnormal coagulation and early onset sepsis are independent risk factors for severe PIVH in premature infants.

The combined exposure to intra-amniotic inflammation and neonatal respiratory distress syndrome increases the risk of intraventricular hemorrhage in preterm neonates.

OBJECTIVE: To evaluate the impact of combined exposure to intra-amniotic inflammation and neonatal respiratory distress syndrome (RDS) on the development of intraventricular hemorrhage (IVH) in preterm neonates. METHODS: This retrospective cohort study includes 207 consecutive preterm births (24.0-33.0 weeks of gestation). Intra-amniotic inflammation was defined as an amniotic fluid matrix metalloproteinase-8 concentration >23 ng/mL. According to McMenamin's classification, IVH was defined as grade II or higher when detected by neurosonography within the first weeks of life. RESULTS: (1) IVH was diagnosed in 6.8% (14/207) of neonates in the study population; (2) IVH was frequent among newborns exposed to intra-amniotic inflammation when followed by postnatal RDS [33% (6/18)]. The frequency of IVH was 7% (8/115) among neonates exposed to either of these conditions - intra-amniotic inflammation or RDS - and 0% (0/64) among those who were not exposed to these conditions; and (3) Neonates exposed to intra-amniotic inflammation and postnatal RDS had a significantly higher risk of IVH than those with only intra-amniotic inflammation [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.1-19.3] and those with RDS alone (OR 5.6, 95% CI 1.0-30.9), after adjusting for gestational age. CONCLUSION: The combined exposure to intra-amniotic inflammation and postnatal RDS markedly increased the risk of IVH in preterm neonates.

Relationship of serum ubiquitin carboxy terminal hydrolase L1 and glial fibrillary acidic protein with brain injury in preterm infants / 临床儿科杂志

Objective To explore the relationship of serum ubiquitin carboxy terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) with brain injury in preterm infants. Methods A total of 130 premature infants with gestational age <34 weeks from August 2014 to October 2016 were recruited. Blood samples were collected at 6 h and 72 h after birth. The levels of serum UCH-L1 and GFAP were detected by ELISA method. According to the results of cranial ultrasound and MRI examination, the premature infants were divided into white matter damage (WMD) group, periventricular intraventricular hemorrhage (PVH-IVH) group, and no brain injury group. The levels of serum UCH-L1 and GFAP in preterm infants between the three groups, mild to severe brain injury were compared. Results At 6 h and 72 h after birth, the levels of serum UCH-L1 and GFAP among no brain injury group, PVH-IVH group and WMD group were significantly different (all P <0.001). The level of serum UCH-L1 and GFAP were the highest in the WMD group and the lowest in no brain injury group at both 6 h and 72 h after birth. The levels of serum UCH-L1 at 72 h after birth were significantly lower than those at 6 h after birth in PVH-IVH group and WMD group, while the levels of serum GFAP at 72 h after birth were significantly higher than those at 6 h after birth in both of the two groups (all P<0.05). The levels of serum UCH-L1 and GFAP in severe PVH-IVH group and severe WMD group were significantly higher than those in the mild group at 6 h and 72 h after birth (all P<0.05). Conclusions The levels of serum UCH-L1 and GFAP in preterm infants can be used as sensitive markers for early evaluation of brain injury, which can help determine the severity of brain injury in preterm infants.

Changes in Cerebral Oxygenation in Preterm Infants With Progressive Posthemorrhagic Ventricular Dilatation.

BACKGROUND: Optimal timing of intervention in neonatal progressive posthemorrhagic hydrocephalus is often a difficult decision. Unchecked hydrocephalus can lead to irreversible brain injury through impaired perfusion, while placement of a shunt is not without long-term morbidity. The purpose of this study was to assess the use of near-infrared spectroscopy to measure changes in regional cerebral oxygen saturation as an indicator of cerebral perfusion in infants with progressive posthemorrhagic ventricular dilatation. METHODS: Near-infrared spectroscopy was used to measure regional cerebral oxygen saturation for more than a one-hour period in infants within 24 hours of cranial ultrasound. Simultaneous pulse oximetry was recorded and oxygen extraction was calculated. Ventricular size was measured by ultrasound using the frontal-occipital horn ratio and compared with average oxygen saturation and oxygen extraction. Statistical analysis was done using the Spearman rank test and analysis of variance. RESULTS: Ventricular measurements were made in 20 very low birth weight premature infants with periventricular-intraventricular hemorrhage and 12 infants with normal ultrasound scans. Ventricular dilatation was associated with lower cerebral oxygen saturation and higher oxygen extraction (P < 0.001). Progressive ventricular dilatation was inversely related to changes in cerebral oxygen saturation (P < 0.001). CONCLUSIONS: Progressive posthemorrhagic ventricular dilatation is associated with a significant decrease in cerebral oxygenation and increase in oxygen extraction suggesting a decrease in cerebral perfusion. Near-infrared spectroscopy could potentially provide additional clinical information to assist in determining optimal timing of surgical intervention in preterm infants with progressive ventricular enlargement.

Clinical analysis of the early extrapulmonary complications in preterm infants with bronchopulmonary dysplasia / 中国小儿急救医学

Objective To clinically analyze the incidence of early extrapulmonary complications in premature infants with bronchopulmonary dysplasia(BPD),including periventricular intraventricular hemorrhage(PVH-IVH),white matter injury(WMI),parenteral nutrition associated cholestasis(PNAC) and metabolic bone disease(MBD),in order to direct the prevention and monitoring of these complications in BPD patients.Methods The clinical data of premature infants who were admitted to the neonatal department between September 2014 and December 2015 was retrospectively analyzed.A total of 87 premature infants diagnosed with BPD were studied as BPD group,while other 90 premature infants without BPD who were hospitalized at the same time were randomly selected as non BPD group.The occurrence of several common extrapulmonary complications was compared between two groups,including PVH-IVH,WMI,PNAC and MBD.Results The incidence of PVH-IVH in BPD group increased compared with non BPD group[(26.4%(23/87) vs 11.1%(10/90)] (P＜0.01),grade Ⅰ-Ⅱ PVH-IVH was more often seen in the BPD group too[24.1%(21/87) vs.11.1%(10/90)](P＜0.05),although the difference between two groups regarding the incidence of grade Ⅲ-Ⅳ PVH-IVH was not significant (P＞0.05).The incidence of WMI in BPD group was much higher than that in non BPD group[33.3%(29/87) vs 16.7%(15/90)] (P＜0.05),especially periventricular leukomalacia,the severe type of WMI,was more often found in BPD group than that in non BPD group[13.7%(12/87) vs 2.2%(2/90)](P＜0.05).The incidences of PNAC[22.9%(20/87) vs 5.5%(5/90)],MBD[17.2%(15/87) vs 3.3%(3/90)] and MBD with imaging changes[6.9%(6/87) vs 0] were all higher in BPD group compared with non BPD group,with significant differences between the two groups (P＜0.05).Conclusion BPD patients are more likely to have early extrapulmonary complications like PVH-IVH,WMI,PNAC and MBD than other preterm infants.It is crucial to prevent these complications reasonably and monitor them regularly for the BPD patients in order to improve the quality of life.

Influence of periventricular-intraventricular hemorrhage on physique and neurodevelopment in premature infants / 中华实用儿科临床杂志

Objective To explore how the severity of periventricular-intraventricular hemorrhage (PIVH)impact on physique and neurodevelopment in premature infants.Methods A total of 80 preterm infants with PIVH admitted to NICU of Qingdao Women and Children's Hospital from December 2013 to June 2015 were eligible.According to the Papile classification,the premature infants were divided into 4 groups.They were grade Ⅰ PIVH group,grade Ⅱ PIVH group,grade Ⅲ PIVH group and grade Ⅳ PIVH group.The infants with grade Ⅰ PIVH and grade Ⅱ PIVH belong to the low-grade PIVH group.The infants with grade Ⅲ PIVH and grade Ⅳ belong to the severe-grade PIVH group.All of them were regularly followed up for 12 months.Neurodevelopmental outcomes of infants at 6 and 12-month correction age were assessed by using the 20 items neuromotor assessment applying for 0-1 year old and the Bayley scales of infant development-Ⅱ.The differences in physical and neurophysical development of premature infants among 4 groups were compared.Results There were no significant differences in physical growth indicators such as body weight,body length and the incidence of weight growth retardation among 4 groups (all P＞0.05).The incidence of neurobehavioral abnormalities in infants with grade Ⅲ-Ⅳ PIVH was significantly higher than that of infants with grade Ⅰ-Ⅱ PIVH at 12-month correction age (21.05％ vs 3.28％,x2 =4.284,P=0.038).Physical development index(PDI) of grade Ⅰ-Ⅱ PIVH infants was significantly higher than that of grade Ⅲ-Ⅳ PIVH infants at 6-month correction age(F=11.500,P＜0.05).At 12-month correction age,grade Ⅰ-Ⅱ PIVH infants showed a significant higher mental development index(MDI) scores and PDI scores than those of grade Ⅲ-Ⅳ PIVH infants(F=14.227,16.515,all P＜0.05).Of the 80 cases assessed,infants with grade Ⅲ-Ⅳ PIVH had significantly higher rates of cerebral palsy(21.05％ vs 1.64％,x2 =6.300,P=0.012) and developmental delay (26.32％ vs 4.92％,x2=5.185,P=0.023) compared with grade Ⅰ-Ⅱ PIVH infants.Conclusions The severe PIVH can have negative effect on the neurodevelopmental outcomes of preterm infants and might induce mental retardation,cerebral palsy and other neurodevelopmental disabilities.Therefore,the regular follow-up and early intervention in preterm infants with PIVH should be implemented to improve the quality of their lives.

Relationship of plasma S100B and MBP with brain damage in preterm infants.

To study the relationships of MBP and S100B with PVH-IVH and PVL in preterm infants. 385 cases of preterm infants, whose gestational age was less than 34 weeks, were enrolled in the study. The plasma levels of S100B and MBP were detected within 24 hours and on the 3rd, 7th, 14th day after birth. Cranial ultrasound was preformed 2-3 d, 1 week, 2 weeks, 3 weeks and 4 weeks after birth. They also received Cranial MRI examination before discharge or when the correct gestational age reached 40 weeks. According to the exclusion standard, 73 cases were excluded. The included 312 cases were divided into 3 groups (no brain damage group, PVH-IVH group and PVL group) according to the result of cranial ultrasound and MRI. The differences of plasma levels of S100B and MBP among groups were compared, and the relationships of the plasma levels of S100B and MBP with gestational age in no brain damage group were analyzed. The results of cranial ultrasound and/or MRI showed: 204 cases had no brain damage (enrolled in no brain damage group); 69 cases had PVH-IVH (enrolled in PVH-IVH group); 27 cases had PVL and 12 cases had PVL and PVH-IVH (both enrolled in PVL group). The plasma level of S100B: within 24 h and on the 3rd d after birth, the serum levels of S100B in PVH-IVH group were significantly higher than those in no brain damage group (P < 0.05); and the plasma levels of S100B in PVL group were significantly higher than those in no brain damage group and PVH-IVH group (all P < 0.05). On 7th d and 14th d after birth, there were no significant differences between PVH-IVH group and no brain damage group (P > 0.05); and the plasma levels of S100B in PVL group were still significantly higher than those in no brain damage group and PVH-IVH group (all P < 0.05). The plasma levels of MBP: within 24 h and on the 3rd d, 7th d and 14th d after birth, there were no significant differences between PVH-IVH group and no brain damage group (all P > 0.05); and the plasma levels of MBP in PVL group were significantly higher than those in no brain damage group and PVH-IVH group (all P < 0.05). Correlation analysis of gestational age and S100B, MBP: the plasma level of S100B in no brain damage group had a negative correlation with gestational age (r = -0.483, P = 0.006), and that of MBP had no correlation with gestational age (r = -0.295, P = 0.105). The plasma levels of S100B and MBP increased significantly in preterm infants with brain damage within 24 h after birth, and the plasma levels of S100B and MBP in PVL infants were higher than those in PVH-IVH infants. The increased plasma levels of S100B and MBP in PVL infants lasted longer than in PVH-IVH infants. The increased plasma levels of S100B and MBP in preterm infants would have certain clinical significance for judging whether early brain damage and PVL would happen.

Ultrasound findings of mild neonatal periventricular-intraventricular hemorrhage after different treatments.

OBJECTIVE: To investigate the ultrasound findings of mild neonatal periventricular-intraventricular hemorrhage (PIVH) after different treatments, and to evaluate the neurological outcomes of mild PIVH with Gesell Development Diagnosis Scale (GDDS). METHODS: A total of 194 newborns with grade I-II PIVH were recruited, and findings of cranial ultrasound examination before and 1 month after birth were included for analysis. The echo intensity and size of the lesions were recorded. RESULTS: There was no significant difference in the echo intensity among three groups of grade I PIVH patients (P>0.05). There was significant difference in the echo intensity among three groups of grade II PIVH patients, and the ganglioside had the best therapeutic efficacy (P<0.05). No significant difference was observed in the area change among three groups of grade I PIVH patients (P>0.05). However, significant difference was observed in the area change among three groups of grade II PIVH patients, and ganglioside had a better efficacy than cerebrolysin and control agent (P<0.05), but there was no significant difference between cerebrolysin and control groups (P>0.05). GDDS evaluation showed no significant difference among three groups (P>0.05), and all the patients recovered completely. CONCLUSION: The efficacy of different treatments for mild PIVH can be reflected in the ultrasound findings. Mild PIVH children generally have a good neurological prognosis.

Relationship of serum neuroglobin and neuron-specific enolase level in preterm infants with brain damage / 国际儿科学杂志

Objective To study the relationships of serum neuroglobin and neuron-specific enolase level with periventricular hemorrhage-intraventricular hemorrhage ( PVH-IVH) and periventricular leucumalacia ( PVL) in preterm infants. Methods There were 241 cases of preterm infants whose gestational age was less than 34 weeks and were admitted in NICU of Guangzhou Women and Children′s Medical Center, Guangzhou Huadu District Matermal and Child Health Hospital and Dongguan Taiping Hospital from Jan. 2010 to May. 2013, enrolled in the study. The serum level of neuroglobin and neuron-specific enolase were detected within 12 hours and on the 3 d, 7 d, 14 d after birth. Cranial ultrasound was preformed 2~3 d, 1week, 2weeks, 3weeks, and 4 weeks after birth. They also received Cranial MRI examination before discharge or when the correct gestational age reached 40 weeks. All 241 cases were divided into 3 groups ( no brain damage group, PVH-IVH group and PVL group) according to the result of cranial US and MRI. The differences of the serum levels of neuroglobin and neuron-specific enolase among each groups were compared. Results The results of cranial ultrasound and /or MRI showed: 162 cases had no brain damage ( in no brain damage group) , 50 cases had PVH-IVH ( in PVH-IVH group) , and 20 cases had PVL, 9 cases had PVL and PVH-IVH ( both in PVL group) . Within 12 h and 3 d after birth, the serum levels of neuroglobin in PVL group and PVH-IVH group was significantly higher than those in no brain damage group (P0. 05 ) , and there were still significantly higher than those in no brain damage group and PVH-IVH group (all P0. 05). On 7 d and 14 d after birth, the serum levels of neuron-specific enolase in PVL group were no significant difference compared with PVH-IVH group and no brain damage group (all P>0. 05). Conclusion The increased serum levels of neuroglobin and neuron-specific enolase in preterm infants within 12 h and 3 d after birth would have certain clinical significance for judging whether early brain damage and PVL would happen.

Risk and protective factors of periventricular-intraventricular hemorrhage in preterm infants / 临床儿科杂志

Objective To identify risk and protective factors of the periventricular-intraventricular hemorrhage (PV-IVH) in preterm infants. Methods By 1:1 case-control study, prenatal and perinatal data were collected and analyzed between preterm infants with PV-IVH and control group from January 2012 to October 2014. The risk and protective factors for the PV-IVH were identiifed by univariate analysis and multivariate conditional logistic regression analysis. Results There were one hundred and thirty-two preterm infants diagnosed of PV-IVH, in which, among whom 6 preterm infants could not be matched to the control infants in the protocol. Finally, 126 pairs of infants were enrolled in the study. There were no differences between two groups in gestational age and birth weight (all P>0.05). Multivariate conditional logistic regression analysis found that BE<-5 mmol/L in the initial blood gas analysis after birth (OR=1.986, 95.0%CI:1.039-3.796), mechanical ventilation (OR=2.913, 95%CI:1.390-6.101), weight gain≤10 g/d in the second week (OR=2.303, 95%CI:1.164-4.558) were risk factors, while number of previous pregnancies≥1 times (OR=0.426, 95%CI:0.229-0.792) was a protective factor for PV-IVH. Conclusions The risk factors of PV-IVH in preterm infants include the lower BE value in the initial blood gas analysis, required mechanical ventilation, and less weight gain in the second week.

Recommendations regarding imaging of the central nervous system in fetuses and neonates.

An abnormal presentation of the central nervous system in a fetus during a screening examination is an indication for extended diagnosis, the aim of which is to explain the character of such an anomaly (a congenital defect, destructive effect of intrauterine infection or abnormality with reasons that are difficult to explain). Knowledge of normal development sequence of the fetal brain, which is discussed in this paper, is the basis for correct interpretation of imaging findings. Together with the increase in survival of preterm neonates, a high risk of early brain damage is still a problem in this extremely immature population. Therefore, imaging examinations become necessary. The paper presents intrauterine and postnatal risk factors of early brain damage as well as classification of such lesions, of hemorrhagic and hypoxic-ischemic etiology. The diagnosis of the cerebellum damage, which is currently believed to be a significant cause of autism, is emphasized. The evolution of lesions over time is also presented. Moreover, the elements of diagnosis important for prognosis are stressed. The standards of imaging examinations of the central nervous system include the schedule of ultrasound examinations and provide indications for extended diagnosis with the use of magnetic resonance imaging.

Relationship of plasma S100B and myelin basic protein level with brain damage in preterm infants / 中华实用儿科临床杂志

Objective To study the relationships of plasma myelin basic protein (MBP) and S100B level with periventricular hemorrhage-intraventricular hemorrhage (PVH-IVH) and periventricular leucumalacia (PVL) in preterm infants.Methods There were 385 cases of preterm infants whose gestational age was less than 34 weeks and were admitted in NICUs of Guangzhou Women and Children's Medical Center of Guangzhou Medical University,Guangzhou Huadu District Maternal and Child Health Hospital and Dongguan Hospital Affiliated to Jinan University from Jan.2010 to Jun.2013,enrolled in the study.The plasma levels of S100B and MBP protein were detected within 24 hours and on the 3rd,7th,14th day after birth.Cranial ultrasound (US) was preformed 2-3 d,1 week,2 weeks,3 weeks and 4 weeks after birth.They also received Cranial MRI examination before discharge or when the correct gestational age reached 40 weeks.According to the exclusion standard 73 cases were excluded.The included 312 cases were divided into 3 groups (no brain damage group,PVH-IVH group and PVL group) according to the result of cranial US and MRI.The differences of the plasma levels of S100B and MBP protein among each groups were compared,and the relationship of the plasma levels of S100B and MBP protein in no brain damage group with gestational age were analyzed.Results The results of cranial ultrasound and/or MRI showed:204 cases had no brain damage (put in no brain damage group),69 cases had PVH-IVH (put in PVH-IVH group),and 27 cases had PVL,12 cases had PVL and PVH-IVH (both put in PVL group).The plasma level of S100B:within 24h and 3 d after birth,the serum levels of S100B in PVH-IVH group were significantly higher than those in no brain damage group (P ＜ 0.05) ; and the plasma levels of S100B in PVL group were significantly higher than those in no brain damage group and PVH-IVH group (all P ＜ 0.05).On 7 d and 14 d after birth,there were no significant differences between PVH-IVH group and no brain damage group (P ＞ 0.05) ;and the plasma levels of S100B of PVL group were still significantly higher than those in no brain damage group and PVH-IVH group (all P ＜0.05).The plasma levels of MBP:within 24 h,3 d,7 d and 14 d after birth,there were no significant differences between PVH-IVH group and no brain damage group (all P ＞ 0.05) ; and the plasma levels of MBP in PVL group were significantly higher than those in no brain damage group and PVH-IVH group (all P ＜ 0.05).Correlation analysis of gestational age and S100B and MBP:the plasma level of S100B in no brain damage group had negative correlation with gestational age (r =-0.483,P =0.006).The plasma level of MBP had no correlation with gestational age (r =-0.295,P =0.105).Conclusions The plasma levels of S100B and MBP increased significantly in preterm infants with brain damage within 24 h after birth,and the plasma levels of S100B and MBP of PVL infants were much higher than PVH-IVH infants.The increased plasma levels of S100B and MBP of PVL infants lasted longer than PVH-IVH infants.The increase of plasma levels of S100B and MBP in preterm infants would have certain clinical significance for judging whether early brain damage and PVL would happen.

Risk factors for hydrocephalus after periventricular-intraventricular hemorrhages in premature infants / 中华实用儿科临床杂志

Objective To study the risk factors for secondary hydrocephalus after periventricular-intraventricular hemorrhage(PVH-IVH) in premature infants.Methods From Jun.2007 to Jun.2012,214 premature infants who were admitted to the Neonatal Intensive Care Unit after birth were enrolled and head ultrasonography showed PVH-IVH from 3 to 7 days after birth.They were classified into PVH-IVH alone group (n =161) and secondary hydrocephalus after PVH-IVH group (n =53) based on the different prognosis.Single factor and multivariate Logistic regression analysis were used to identify risk factors for secondary hydrocephalus after PVH-IVH.Results Single analysis indicated 8 factors associated with hydrocephalus after PVH-IVH,including male,gestational age ＜ 28 weeks,birth weight ＜ 1000 g,severe asphyxia,PVH-IVH Ⅲ or Ⅳ,metabolic acidosis,hyponatremia,and hypoglycemia or hyperglycemia (all P ＜0.05) ;multivariate Logistic regression analysis showed that male (OR =3.317),severe asphyxia (OR =13.838),PVH-IVH Ⅲ or Ⅳ (OR =43.281),and hyponatremia (OR =2.731) were independent risk factors for hydrocephalus after PVH-IVH (all P ＜ 0.05).Conclusions Male,severe asphyxia,PVH-IVH Ⅲ or Ⅳ,and hyponatremia are closely related to hydrocephalus after PVH-IVH in preterm infants.After PVH-IVH,these clinical risk factors should be followed closely in the prevention of hydrocephalus.

General evaluation of periventricular-intraventricular hemorrhage in premature infants in mainland China.

OBJECTIVE: To explore the incidence and analyze the high risk factors of PIVH in premature infants in mainland China. MATERIALS AND METHODS: A total of 1122 premature infants at <37 weeks gestation were enrolled in this study. All the infants received intracranial ultrasound examinations within 1 week after birth, and the perinatal data were recorded to analyze the high risk factors for PIVH. RESULTS: The results showed that the incidence rate of PIVH was 55.2% in mainland Chinese population. Among these cases, mild degrees of PIVH accounted for 82.2% and severe degrees of PIVH accounted for only 17.8%. The most important risk factors related to PIVH were low gestational age, low birth weight, low Apgar score and ventilatory treatment, etc. CONCLUSIONS: It suggested that there were many high risk factors related to PIVH in premature infants and a screening cutoff point of 2000 g appeared to be more adequate for China.

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

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.

Development of Periventricular Leukomalacia and Severe Intraventricular Hemorrhage in Very Low Birth Weight Newborns and Relationship with Ventilator Care (Study of Ventilator Care as a Risk Factor of PVL and PV-IVH) / 소아과

PURPOSE: It has been suggested that changes in cerebral blood flow by ventilator care could be a risk factor in periventricular leukomalacia (PVL) and severe periventricular-intraventricular hemorrhage (PV-IVH). The study aims to assess the relationship between perinatal clinical events, including ventilator care, and the development of PVL and severe PV-IVH; especially, whether ventilator care could be causers of PVL and severe PV-IVH as an individual risk factor. METHODS: Among 255 very low birth weight infants who survived in the Fatima neonatal intensive care unit from January 1999 to December 2003, 15 infants with PVL and eight infants with severe PV-IVH were classified as a study group, while 231 infants were enrolled as a control group. The analysis was performed retrospectively with medical records. RESULTS: Twenty four infants were diagnosed with PVL or severe PV-IVH. Asphyxia, recurrent apnea, sepsis, acidosis and ventilator care were significantly increased in the PVL goup. Asphyxia, recurrent apnea, RDS, acidosis and ventilator care were significantly increased in the severe PV-IVH group. CONCLUSION: Infants with PVL or severe PV-IVH may have multiple perinatal risk factors including asphyxia, recurrent apnea, sepsis, acidosis, RDS and ventilator care. Because most patients with ventilator care have multiple perinatal risk factors, ventilator care does not cause PVL and severe PV- IVH independently. Therefore, incidences of PVL and severe PV-IVH can be decreased by not only gentle ventilation, but also more professional antenatal care.

Neurosonographic diagnosis of periventricular-intraventricular hemorrhage in low birth weight infants

Periventricular-intraventricular hemorrhage (PV-IVH)is one of the most important neurologic lesion of the low birth weight infants. Serial neurosonographic exeaminations were performed in 113 low birth weight infants who were admitted to the neonatal intensive care unit of Presbyterian Medical Center from November 1, 1990to July 31, 1991. The results were summarized as follows: 1) The incidence of PV-IVH in the study was 54% 2) According to Papile's grading system of PV-IVH, grade I was 32.8%, grade II was 45.9%, grade IIIwas 11.5% and grade IV was 9.8%. 3) The onset of PV-IVH was within the first 7 days of life in 82%. 4) Poor activity, apnea, bradycardia and hypotension were statistically significant clinical findings associated with PV-IVH(P<0.05). 5) The risk factors associated with PV-IVH were gestational age, birth weight, hyaling membrane disease, patent ductus arteriosus and artifical ventilation. 6) The mortality of PV-IVH was 0% for grade I, 10.7% for grade II,42.9% for grade III and 83.3% for gradeIV.