[预测早产儿严重脑室内出血的发生及预防其发展的方法]

[Predicting the occurrence of severe intraventricular hemorrhages and ways to prevent their development in preterm infants].

作者信息

Kovalova Olena M, Pokhylko Valeriy I, Bielorus Andrey I, Soloviova Halina O, Cherniavska Yuliia I, Adamchuk Nataliia N

机构信息

Ukrainian Medical Stomatological Academy, Poltava, Ukraine.

The Perinatal Center of the Poltava Regional Clinical Hospital Named After M.V. Sklifosovsky, Poltava, Ukraine.

出版信息

Wiad Lek. 2018;71(8):1524-1530.

PMID:30684335

Abstract

OBJECTIVE

Introduction: Severe intraventricular hemorrhages (IVH) in preterm infants are one of the major public health problems, as they can cause neurological and cognitive impairment, as well as lethal outcomes. The aim: To prevent the development of IVH in preterm infants by developing an algorithm for identification of high risk infants and a bundle for the prediction and prevention of this pathology.

PATIENTS AND METHODS

Materials and methods: A multicenter study (2013-2016) was conducted, which included 117 premature babies who were on treatment in 4 medical institutions in the Poltava region (Ukraine). The group of children with severe IVH included 76 children (weight 1037.8 ± 43.7 g, gestational age (GA) 27.1 ± 0.27 weeks; girls 36/47, 37 %), with IVH III-IV st. by Papile L.A. The comparison group consisted of 41 children (weight 1758 ± 59.8, GA 32.1 ± 0.30 weeks, girls 15/38, 46 %) without IVH. The effectiveness of a bundle for the prediction and prevention severe IVH was studied in the Poltava Regional Perinatal Center (high level, 2000 births per year) during 2014 - 2017.

RESULTS

Results: The significant risk factors due to multiple regression logistic analysis are: gestational age (OR =0.28, р=0.000), anhydrous period less than 24 hours (OR =83,29; р=0.020), infusion of 0.9% sodium chloride solution during primary resuscitation (OR =16.73; р=0.042), episodes of arterial hypertension (OR =32.3; р=0.026), the number of leukocytes is ≥15x109/l at birth (OR=17.6; р=0.028). After the implementation of the Bundle, which included: an interdisciplinary check-list (between the obstetrician and the neonatologist), the algorithm for identifying children with high risk of IVH, a check-list for monitoring of the state of the child immediately after birth and an interprofessional check-list (between the doctor and the nurse), the IVH incidence decreased from 18.9 % to 11.4 %, p = 0.038, and the disability from 9.6 % to 2.4 %, p = 0.046.

CONCLUSION

Conclusions: The Bundle is an effective tool for preventing of severe IVH in preterm infants.

摘要

目的

引言：早产儿严重脑室内出血（IVH）是主要的公共卫生问题之一，因为它可导致神经和认知障碍以及致命后果。目的：通过制定高危婴儿识别算法和用于预测及预防该病症的综合措施，预防早产儿发生IVH。

患者与方法

材料与方法：开展了一项多中心研究（2013 - 2016年），纳入了在乌克兰波尔塔瓦地区4家医疗机构接受治疗的117名早产儿。重度IVH患儿组包括76名儿童（体重1037.8±43.7克，胎龄（GA）27.1±0.27周；女孩36/47，占37%），根据Papile L.A.分级为III - IV级IVH。对照组由41名无IVH的儿童组成（体重1758±59.8克，GA 32.1±0.30周，女孩15/38，占46%）。2014 - 2017年期间，在波尔塔瓦地区围产中心（高水平，每年分娩2000例）研究了用于预测和预防重度IVH的综合措施的有效性。

结果

结果：多元回归逻辑分析得出的显著危险因素为：胎龄（OR = 0.28，p = 0.000）、无水期小于24小时（OR = 83.29；p = 0.020）、初次复苏期间输注0.9%氯化钠溶液（OR = 16.73；p = 0.042）、动脉高血压发作（OR = 32.3；p = 0.026）、出生时白细胞计数≥15×10⁹/L（OR = 17.6；p = 0.028）。实施包括以下内容的综合措施后：一份跨学科检查表（产科医生和新生儿科医生之间）、IVH高危儿童识别算法、出生后立即监测儿童状况的检查表以及一份跨专业检查表（医生和护士之间），IVH发生率从18.9%降至11.4%，p = 0.038，残疾率从9.6%降至2.4%，p = 0.046。