Jiang Lijun, Yu Qian, Wang Fudong, Wu Mingfu, Liu Feng, Fu Mingfeng, Gao Junyan, Feng Xing, Zhang Longfeng, Xu Zhenxing
Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, China.
Department of Neonatology, Affiliated Children's Hospital of Soochow University, Suzhou, China.
Front Pediatr. 2023 Oct 9;11:1241809. doi: 10.3389/fped.2023.1241809. eCollection 2023.
Hemodynamic instability is the main factor responsible for the development of intraventricular hemorrhage (IVH) in premature newborns. Herein, we evaluated the predictive ability of blood pressure variability (BPV) and anterior cerebral artery (ACA) blood flow parameters in IVH in premature infants with gestational age (GA) ≤32 weeks and birth weight (BW) ≤ 1,500 g.
Preterm infants with GA ≤32 weeks and BW ≤ 1,500 g admitted to the neonatal intensive care unit (NICU) of the hospital affiliated to Yangzhou University from January 2020 to January 2023 were selected as the research subjects. All preterm infants were admitted within 1 h after birth, and systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MABP) were monitored at 1-h intervals. The difference between maximum and minimum values (max-min), standard deviation (SD), coefficient of variation (CV), and successive variation (SV) were used as BPV indicators. On the 1st, 3rd, and 7th day after birth, transcranial ultrasound examination was performed to screen for the occurrence of IVH. On the 24 ± 1 h after birth, systolic velocity (Vs), diastolic velocity (Vd), and resistance index (RI) of the ACA were measured simultaneously. Preterm infants were divided into the IVH group and non-IVH group based on the results of transcranial ultrasound examination, and the correlation between BPV indicators, ACA blood flow parameters, and development of IVH was analyzed.
A total of 92 premature infants were enrolled, including 49 in the IVH group and 43 in the non-IVH group. There was no statistically significant difference in baseline characteristics such as BW, GA, sex, and perinatal medical history between the two groups of preterm infants ( > 0.05). The SBP SD (OR: 1.480, 95%CI: 1.020-2.147) and ACA-RI (OR: 3.027, 95%CI: 2.769-3.591) were independent risk factors for IVH in premature newborns. The sensitivity and specificity of combined detection of SBP SD and ACA-RI in predicting IVH were 61.2% and 79.1%, respectively.
High BPV and ACA-RI are related to IVH in premature infants with GA ≤32 w and BW ≤1,500 g. Combined detection of SBP SD and ACA-RI has a certain predictive effect on early identification of IVH.
血流动力学不稳定是早产新生儿脑室内出血（IVH）发生发展的主要因素。在此，我们评估了血压变异性（BPV）和大脑前动脉（ACA）血流参数对孕周（GA）≤32周且出生体重（BW）≤1500g的早产婴儿IVH的预测能力。
选取2020年1月至2023年1月在扬州大学附属医院新生儿重症监护病房（NICU）收治的GA≤32周且BW≤1500g的早产儿作为研究对象。所有早产儿均在出生后1小时内入院，每隔1小时监测收缩压（SBP）、舒张压（DBP）和平均动脉压（MABP）。采用最大值与最小值之差（max-min）、标准差（SD）、变异系数（CV）和连续变异（SV）作为BPV指标。在出生后第1、3和7天进行经颅超声检查以筛查IVH的发生情况。在出生后24±1小时同时测量ACA的收缩期速度（Vs）、舒张期速度（Vd）和阻力指数（RI）。根据经颅超声检查结果将早产儿分为IVH组和非IVH组，分析BPV指标、ACA血流参数与IVH发生发展之间的相关性。
共纳入92例早产儿，其中IVH组49例，非IVH组43例。两组早产儿在BW、GA、性别和围产期病史等基线特征方面差异无统计学意义（P>0.05）。SBP标准差（OR：1.480，95%CI：1.020-2.147）和ACA阻力指数（OR：3.027，95%CI：2.769-3.591）是早产新生儿IVH的独立危险因素。联合检测SBP标准差和ACA阻力指数预测IVH的敏感度和特异度分别为61.2%和79.1%。
高BPV和ACA阻力指数与GA≤32周且BW≤1500g的早产婴儿IVH有关。联合检测SBP标准差和ACA阻力指数对早期识别IVH有一定的预测作用。
