El Shimi M Sami, Hassanein Sahar M A, Mohamed Maha H, Abdou Rania M, Roshdy Ahmed, Atef Shereen H, Aly Hany
Department of Paediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Matern Fetal Neonatal Med. 2012 Sep;25(9):1586-90. doi: 10.3109/14767058.2011.648236. Epub 2012 Feb 10.
Intraventricular haemorrhage (IVH) is a major problem in premature infants. Our objective is to assess the early predictive value of vascular endothelial growth factor (VEGF) for development of IVH and management of its squeal in preterm neonates.
We prospectively studied 150 preterm neonates (PT) less than 34 weeks gestation. Fifty of them completed the study. 30/50 developed IVH during follow up, and 20 did not. First 24 hours, and 3(rd) day serum samples were collected. Cerebrospinal fluid (CSF) samples were withdrawn for 10 IVH patients.
Serum VEGF; both samples were increased in IVH compared to non-IVH group (P=0.001). PHVD-group (n=10) had higher VEGF in both samples than resolved IVH (P=0.004), (P=0.005). While, VEGF increased in the IVH group 2(nd) sample compared to 1(st) (P=0.000), it decreased in non-IVH group, P=0.033). Each 1 unit increase in 1(ST) VEGF increased the risk of occurrence of IVH by 1.6%. 3(rd) day VEGF at a cut-off value of 135 pg/ml is 96% sensitive and 100% specific to predict PHVD. Serum VEGF inversely correlated with TLC, pH, PO(2) and HCO(3), and positively correlated with PCo(2) and FiO(2).
Serum VEGF predicts development of IVH and PHVD in PT neonates. Also, high CSF level of VEGF could predict the need for permanent shunt placement.
脑室内出血（IVH）是早产儿的一个主要问题。我们的目的是评估血管内皮生长因子（VEGF）对早产儿IVH发生及其后遗症管理的早期预测价值。
我们前瞻性地研究了150例孕周小于34周的早产儿（PT）。其中50例完成了研究。在随访期间，50例中有30例发生了IVH，20例未发生。收集了出生后前24小时及第3天的血清样本。为10例IVH患者抽取了脑脊液（CSF）样本。
与非IVH组相比，IVH组的两个血清样本中的VEGF均升高（P = 0.001）。PHVD组（n = 10）的两个样本中的VEGF均高于IVH已缓解组（P = 0.004），（P = 0.005）。IVH组的第2个样本中的VEGF相比于第1个样本升高了（P = 0.000），而非IVH组则降低了（P = 0.033）。第1个VEGF每升高1个单位，IVH发生风险增加1.6%。第3天VEGF截断值为135 pg/ml时，预测PHVD的敏感性为96%，特异性为100%。血清VEGF与TLC、pH、PO₂和HCO₃呈负相关，与PCo₂和FiO₂呈正相关。
血清VEGF可预测PT新生儿IVH和PHVD的发生。此外，脑脊液中高VEGF水平可预测永久性分流管置入的必要性。
