安徽省住院早产儿脑损伤多中心流行病学调查
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摘要
目的开展安徽省住院早产儿脑损伤多中心流行病学调查,探讨早产儿脑损伤发生的危险因素,为其早期预防和治疗提供循证依据。方法以2016年1月至2017年1月安徽省新生儿协作网9家医院新生儿科住院早产儿为研究对象,收集早产儿母亲妊娠资料及早产儿出生资料和住院资料,采用logistic回归模型分析早产儿脑损伤发生的危险因素。结果共纳入3 378例早产儿,脑室周围-脑室内出血(PVH-IVH)发生率为23.56%(798/3 387),脑室周围白质软化(PVL)发生率为2.60%(88/3 387)。宫内窘迫、贫血、低血糖、坏死性小肠结肠炎(NEC)为PVH-IVH发生的危险因素(OR分别为1.310、1.591、1.835、3.310,P<0.05),较大胎龄为PVH-IVH发生的保护因素(OR为0.671,P<0.05)。PVH-IVH、NEC和应用机械通气是PVL发生的危险因素(OR分别为4.017、3.018、 2.166,P<0.05),女性和应用肺表面活性物质是PVL的保护因素(OR分别为0.514、0.418,P<0.05)。结论窒息缺氧、感染/炎症、应用机械通气、贫血、低血糖等因素可增加早产儿脑损伤发生的风险。
Objective To investigate the risk factors for brain injury in preterm infants by a multicenter epidemiological investigation of brain injury in hospitalized preterm infants in Anhui, China. Methods Preterm infants who were hospitalized in the department of neonatology in 9 hospitals of Anhui Neonatal Collaboration Network between January 2016 and January 2017 were enrolled as subjects. The data of maternal pregnancy and clinical data of preterm infants were collected, and the logistic regression model was used to analyze the risk factors for brain injury in preterm infants. Results A total of 3 378 preterm infants were enrolled. Of the 3 378 preterm infants, 798(23.56%) had periventricular-intraventricular hemorrhage(PVH-IVH), and 88(2.60%) had periventricular leukomalacia(PVL). Intrauterine distress, anemia, hypoglycemia and necrotizing enterocolitis(NEC) were risk factors for PVH-IVH(OR=1.310, 1.591, 1.835, and 3.310 respectively; P<0.05), while a higher gestational age was a protective factor against PVH-IVH(OR=0.671, P<0.05). PVH-IVH, NEC and mechanical ventilation were risk factors for PVL(OR=4.017, 3.018, and 2.166 respectively; P<0.05), and female sex and use of pulmonary surfactant were protective factors against PVL(OR=0.514 and 0.418 respectively; P<0.05). Conclusions Asphyxia/anoxia, infection/inflammation, mechanical ventilation, anemia and hypoglycemia may increase the risk of brain injury in preterm infants.
Objective To investigate the risk factors for brain injury in preterm infants by a multicenter epidemiological investigation of brain injury in hospitalized preterm infants in Anhui, China. Methods Preterm infants who were hospitalized in the department of neonatology in 9 hospitals of Anhui Neonatal Collaboration Network between January 2016 and January 2017 were enrolled as subjects. The data of maternal pregnancy and clinical data of preterm infants were collected, and the logistic regression model was used to analyze the risk factors for brain injury in preterm infants. Results A total of 3 378 preterm infants were enrolled. Of the 3 378 preterm infants, 798(23.56%) had periventricular-intraventricular hemorrhage(PVH-IVH), and 88(2.60%) had periventricular leukomalacia(PVL). Intrauterine distress, anemia, hypoglycemia and necrotizing enterocolitis(NEC) were risk factors for PVH-IVH(OR=1.310, 1.591, 1.835, and 3.310 respectively; P<0.05), while a higher gestational age was a protective factor against PVH-IVH(OR=0.671, P<0.05). PVH-IVH, NEC and mechanical ventilation were risk factors for PVL(OR=4.017, 3.018, and 2.166 respectively; P<0.05), and female sex and use of pulmonary surfactant were protective factors against PVL(OR=0.514 and 0.418 respectively; P<0.05). Conclusions Asphyxia/anoxia, infection/inflammation, mechanical ventilation, anemia and hypoglycemia may increase the risk of brain injury in preterm infants.
引文
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[20]Kaur C,Rathnasamy G,Ling EA.Roles of activated microglia in hypoxia induced neuroinflammation in the developing brain and the retina[J].J Neuroimmune Pharmacol,2013,8(1):66-78.
[21]Li B,Concepcion K,Meng X,et al.Brain-immune interactions in perinatal hypoxic-ischemic brain injury[J].Prog Neurobiol,2017,159:50-68.
[22]Kidokoro H,Anderson PJ,Doyle LW,et al.Brain injury and altered brain growth in preterm infants:predictors and prognosis[J].Pediatrics,2014,134(2):e444-e453.
[23]Klebermass-Schrehof K,Wald M,Schwindt J,et al.Less invasive surfactant administration in extremely preterm infants:impact on mortality and morbidity[J].Neonatology,2013,103(4):252-258.
[24]Kribs A,Roll C,G?pel W,et al.Nonintubated surfactant application vs conventional therapy in extremely preterm infants:a randomized clinical trial[J].JAMA Pediatr,2015,169(8):723-730.
[25]Kumral A,Iscan B,Engur D,et al.Intranasal surfactant protein D as neuroprotective rescue in a neonatal rat model of periventricular leukomalacia[J].J Matern Fetal Neonatal Med,2017,30(4):446-451.
[26]Resch B,Resch E,Maurer-Fellbaum U,et al.The whole spectrum of cystic periventricular leukomalacia of the preterm infant:results from a large consecutive case series[J].Childs Nerv Syst,2015,31(9):1527-1532.
[2]He SW,Xiong YE,Zhu LH,et al.Impact of family integrated care on infants'clinical outcomes in two children's hospitals in China:a pre-post intervention study[J].Ital J Pediatr,2018,44(1):65.
[3]Beaino G,Khoshnood B,Kaminski M,et al.Predictors of the risk of cognitive deficiency in very preterm infants:the EPIPAGEprospective cohort[J].Acta Paediatr,2011,100(3):370-378.
[4]中华医学会儿科学分会新生儿学组,《中华儿科杂志》编辑委员会.早产儿脑室周围-脑室内出血与脑室周围白质软化的诊断建议[J].中华儿科杂志,2007,45(1):34-36.
[5]Stoll BJ,Hansen NI,Bell EF,et al.Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network[J].Pediatrics,2010,126(3):443-456.
[6]陈惠金,魏克伦,周丛乐,等.中国七大城市早产儿脑损伤发生率的多中心调查报告[J].临床儿科杂志,2011,29(11):1001-1011.
[7]Kong X,Xu F,Wu R,et al.Neonatal mortality and morbidity among infants between 24 to 31 complete weeks:a multicenter survey in China from 2013 to 2014[J].BMC Pediatr,2016,16(1):174.
[8]王晓琴,王莹,李红.早产儿脑损伤的危险因素[[J].中国新生儿科杂志,2015,30(4):286-288.
[9]Beausoleil TP,Janaillac M,Barrington KJ,et al.Cerebral oxygen saturation and peripheral perfusion in the extremely premature infant with intraventricular and/or pulmonary haemorrhage early in life[J].Sci Rep,2018,8(1):6511.
[10]Lu H,Wang Q,Lu J,et al.Risk factors for intraventricular hemorrhage in preterm infants born at 34 weeks of gestation or less following preterm premature rupture of membranes[J].JStroke Cerebrovasc Dis,2016,25(4):807-812.
[11]徐发林,段佳佳,张彦华,等.机械通气早产儿脑室周围-脑室内出血临床高危因素分析[J].中国当代儿科杂志,2012,14(11):838-841.
[12]Szpecht D,Szymankiewicz M,Nowak I,et al.Intraventricular hemorrhage in neonates born before 32 weeks of gestationretrospective analysis of risk factors[J].Childs Nerv Syst,2016,32(8):1399-1404.
[13]Christensen RD,Lambert DK,Baer VL,et al.Severe neonatal anemia from fetomaternal hemorrhage:report from a multihospital health-care system[J].J Perinatol,2013,33(6):429-434.
[14]刘冲冲,谭玮,唐文燕.早产儿脑室周围-脑室内出血高危因素分析[J].江西医药,2017,52(8):741-745.
[15]Oh KJ,Park JY,Lee J,et al.The combined exposure to intraamniotic inflammation and neonatal respiratory distress syndrome increases the risk of intraventricular hemorrhage in preterm neonates[J].J Perinat Med,2018,46(1):9-20.
[16]Auerbach A,Eventov-Friedman S,Arad I,et al.Long duration of hyperglycemia in the first 96 hours of life is associated with severe intraventricular hemorrhage in preterm infants[J].J Pediatr,2013,163(2):388-393.
[17]Huang J,Zhang L,Kang B,et al.Association between perinatal hypoxic-ischemia and periventricular leukomalacia in preterm infants:a systematic review and meta-analysis[J].PLo S One,2017,12(9):e0184993.
[18]Wang LW,Lin YC,Tu YF,et al.Isolated cystic periventricular leukomalacia differs from cystic periventricular leukomalacia with intraventricular hemorrhage in prevalence,risk factors and outcomes in preterm infants[J].Neonatology,2017,111(1):86-92.
[19]Kusters CD,Chen ML,Follett PL,et al.''Intraventricular''hemorrhage and cystic periventricular leukomalacia in preterm infants:how are they related?[J].J Child Neurol,2009,24(9):1158-1170.
[20]Kaur C,Rathnasamy G,Ling EA.Roles of activated microglia in hypoxia induced neuroinflammation in the developing brain and the retina[J].J Neuroimmune Pharmacol,2013,8(1):66-78.
[21]Li B,Concepcion K,Meng X,et al.Brain-immune interactions in perinatal hypoxic-ischemic brain injury[J].Prog Neurobiol,2017,159:50-68.
[22]Kidokoro H,Anderson PJ,Doyle LW,et al.Brain injury and altered brain growth in preterm infants:predictors and prognosis[J].Pediatrics,2014,134(2):e444-e453.
[23]Klebermass-Schrehof K,Wald M,Schwindt J,et al.Less invasive surfactant administration in extremely preterm infants:impact on mortality and morbidity[J].Neonatology,2013,103(4):252-258.
[24]Kribs A,Roll C,G?pel W,et al.Nonintubated surfactant application vs conventional therapy in extremely preterm infants:a randomized clinical trial[J].JAMA Pediatr,2015,169(8):723-730.
[25]Kumral A,Iscan B,Engur D,et al.Intranasal surfactant protein D as neuroprotective rescue in a neonatal rat model of periventricular leukomalacia[J].J Matern Fetal Neonatal Med,2017,30(4):446-451.
[26]Resch B,Resch E,Maurer-Fellbaum U,et al.The whole spectrum of cystic periventricular leukomalacia of the preterm infant:results from a large consecutive case series[J].Childs Nerv Syst,2015,31(9):1527-1532.