新生儿低血糖脑损伤预后评估

Evaluation of prognosis of neonatal hypoglycemic brain injury

目的观察不同程度的低血糖对新生儿脑损伤预后的影响。方法选取2015年3月~2018年7月潍坊医学院附属医院新生儿科120例不同程度的低血糖患儿。根据新生儿低血糖的程度分为3组,分别为A组32例,B组40例,C组48例(A组≤1.0mmol/L,B组~1.7mmol/L,C组~2.2mmol/L),对各组患儿在胎龄40周、42周、44周(早产儿要纠正到相应胎龄)进行新生儿神经行为评分(NBNA)。治疗12个月后对各组患儿进行随访,采用AIberta婴儿运动量表(AIMS)进行预后评估。结果C组和B组患儿在胎龄40周和42周的NBNA评分差值高于A组(P<0.05);C组和B组患儿在胎龄42周和44周的NBNA评分差值高于A组(P<0.05)。A,B,C 3组12个月后随访出现神经行为异常的比例分别为37.5%,10.0%,2.1%,组间比较,差异有统计学意义(P<0.05),且3组患儿的AIMS评分比较,差异有统计学意义(P<0.05)。结论新生儿不同程度的低血糖所导致的脑损伤的预后情况差异较大,血糖水平越低,低血糖持续时间越长,NBNA评分越低,AMIS评分评分越低,出现神经行为异常的比例越高,脑损伤的程度越重,预后越差。因此,针对不同程度的低血糖患儿应采取不同的治疗措施,并尽量在入院后24h内纠正血糖水平,减少低血糖脑损伤发生的风险。

Objective To explore the effect of different degrees of hypoglycemia on the prognosis of neonatal brain injury.Methods From March 2015 to July 2018,120 children with hypoglycemia were selected from the Department of Neonatology,the Affliated Hospital of Weifang Medical University.According to the degree of neonatal hypoglycemia,they were divided into three groups:group A(32 cases),group B(40 cases)and group C(48 cases),(group A≤1.0mo1/L,group B^1.7mno1/L,group C^2.2mno1/L).Neonatal neurobehavioral scores(NBNA)were performed in each group at 40 weeks,42 weeks,and 44 weeks of gestational age(premature infants were corrected to the corresponding gestational age).The patients in each group were followed up 12 months after treatment,and the prognosis was assessed using the Aiberta Infant Exercise Scale(AIMS).Results Differences in NBNA scores between 40 and 42 weeks and scores between 42 and 44 weeks of gestational age in group C and group B were higher than in group A(P<0.05).After 12-months’follow-up,the proportion of neurobehavioral abnormalities in these 3 groups was 37.5%,10.0%,and 2.1%,respectively,which has significant difference(P<0.05),and the difference in AIMS scores among the three groups was statistically significant(P<0.05).Conclusions The prognosis of brain injury caused by different degrees of hypoglycemia in newborn infants varies greatly.The lower the blood sugar level,the longer the duration of hypoglycemia,the lower the NBNA score,the lower the AIMS score,the higher the proportion of neurobehavioral abnormalities,the severer the brain injury,and the worse the prognosis.Therefore,different treatment measures should be taken for children with different degrees of hypoglycemia,and try to correct the blood sugar level within 24 hours after admission to reduce the risk of hypoglycemic brain damage.