280例早产儿颅脑的彩超表现、NBNA评分及其与脑损伤的相关性

Color Doppler ultrasonography and NBNA score of 280 premature infants and their correlation with brain injury

目的:探讨早产儿颅脑彩超表现、新生儿行为神经测定(ne onatal behavioral neurological assessment,NBNA)评分状况及其与脑损伤的相关性。方法:选取2018年6月至2020年1月于海南西部中心医院出生的280例早产儿为研究对象,所有早产儿均于出生第5天行颅脑彩超检查,且均于出生后第3、7、14、28天行NBNA评分。根据《早产儿脑损伤诊断与防治专家共识》统计住院期间早产儿脑损伤发生状况及严重程度,根据胎龄将脑损伤早产儿分为<31周组、31~35周组、>35周组,并分析早产儿颅脑彩超表现、NBNA评分状况及其与脑损伤的相关性。结果:颅脑彩超检查结果显示:280例早产儿中共有79例发生脑损伤,脑损伤发生率为28.21%,其中Ⅰ~Ⅱ级46例,Ⅲ级17例,Ⅳ级16例。不同胎龄脑损伤早产儿的各时间点NBNA评分比较,差异有统计学意义(P<0.05);不同胎龄脑损伤早产儿的NBNA评分均随日龄的增长而升高,差异均有统计学意义(P<0.05)。颅脑彩超检查结果与住院期间早产儿脑损伤发生状况及严重程度具有较高一致性(Kappa值=0.802,P<0.001)。Ⅰ~Ⅱ级、Ⅲ级、Ⅳ级组早产儿的NBNA评分均明显低于无脑损伤组,且Ⅲ级、Ⅳ级组早产儿的NBNA评分明显低于Ⅰ~Ⅱ级组,Ⅳ级组早产儿的NBNA评分明显低于Ⅲ级组,差异均有统计学意义(均P<0.05)。线性回归分析结果显示:NBNA评分与脑损伤分级呈负相关(P<0.05)。受试者工作特征(receiver operating characteristics,ROC)曲线分析显示:NBNA评分诊断早产儿脑损伤的曲线下面积(area under the curve,AUC)为0.839,灵敏度为87.14%,特异度为79.64%。结论:早产儿颅脑彩超表现、NBNA评分状况与其脑损伤有一定相关性,行颅脑彩超检查可以有效评估早产儿脑损伤严重程度,行NBNA评分可以早期诊断早产儿脑损伤的发生。

Objective:To investigate the correlation between the color Doppler ultrasonography of the brain of premature infants and the score of neonatal behavioral neurological assessment(NBNA)and brain injury.Methods:A total of 280 premature infants born in our hospital from June 2018 to January 2020 were selected as the study subjects.All premature infants underwent brain ultrasound examination on the 5 th day of birth,and NBNA scores were performed on the 3 rd,7 th,14 th and 28 th day after birth.The occurrence and severity of brain injury in premature infants during hospitalization were analyzed according to the Diagnostic Criteria for Ischemic Hypoxic Encephalopathy of Newborns,the premature infants with brain injury were divided into a<31 weeks group,a31-35 weeks group and a>35 weeks group according to gestational age,and the brain color Doppler ultrasound performance,NBNA score and their correlation with brain injury were analyzed.Results:The results of craniocerebral ultrasonography showed that a total of 79 cases of 280 premature infants had brain injury,and the incidence of brain injury was 28.21%,including 46 cases of gradeⅠ-Ⅱ,17 cases of gradeⅢand 16 cases of gradeⅣ.The NBNA scores of premature infants with brain injury at different gestational ages were significantly different at different time points(P<0.05);the NBNA scores of premature infants with brain injury of different gestational ages increased with the increase of age,and the differences were statistically significant(P<0.05).The results of craniocerebral ultrasonography showed a high consistency with the occurrence and severity of brain injury during hospitalization(Kappa value=0.802,P<0.001).The NBNA scores of gradeⅠ-Ⅱ,ⅢandⅣpremature infants were significantly lower than that in the group without brain injury,the NBNA score of premature infants in gradeⅢandⅣgroups were significantly lower than that in gradeⅠ-Ⅱgroups,and NBNA score of premature infants in gradeⅣgroup was significantly lower than that in gradeⅢgroup,the difference were statistically significant(P<0.05).The results of linear regression analysis showed that NBNA score was negatively correlated with brain injury grade(P<0.05);the receiver operating characteristics(ROC)curve analysis showed that the area under the curve(AUC)of NBNA score was 0.839,the sensitivity was 87.14%,and the specificity was 79.64%.Conclusion:The brain color Doppler ultrasonography and NBNA score of premature infants are correlated with brain injury to some extent,the brain color Doppler ultrasonography can effectively assess the severity of brain injury in premature infants,and NBNA score can early diagnose the occurrence of brain injury in premature infants.