足月新生儿重度脑室内出血预后不良危险因素分析

A study on the risk factors for poor prognosis in term infants with severe intraventricular hemorrhage

目的探讨足月新生儿重度脑室内出血(severe intraventricular hemorrhage,SIVH)预后不良的危险因素。方法选取2016年1月至2022年9月湖南省儿童医院新生儿科收治的SIVH足月新生儿进行回顾性分析。根据12月龄时预后分为预后良好组和预后不良组。采用单因素及二元logistic回归分析预后不良的危险因素,并使用受试者工作特征(receiver operating characteristic,ROC)曲线评估侧脑室前角宽度(anterior horn width,AHW)值对预后不良的预测价值。结果共纳入SIVH足月新生儿80例,其中预后良好组39例,预后不良组41例。预后不良组新生儿惊厥、振幅整合脑电图重度异常、脑白质损伤比例、诊断日龄、AHW值均大于预后良好组(P<0.05)。二元logistic回归分析显示,AHW值增大(OR=1.257,95%CI 1.104~1.431,P=0.001)、脑白质损伤(OR=5.569,95%CI 1.558~19.908,P=0.008)是足月新生儿SIVH预后不良的独立危险因素(P<0.05)。ROC曲线分析显示,AHW值≥13.5 mm提示足月新生儿SIVH预后不良,其灵敏度和特异度分别为63.4%和76.9%。结论脑白质损伤和重度脑室扩张是足月儿SIVH预后不良的独立危险因素,当AHW值≥13.5 mm时发生预后不良的风险较高。

ObjectiveTo study the risk factors for poor prognosis in term infants with severe intraventricular hemorrhage(SIVH).Methods A retrospective analysis was conducted on term infants with SIVH in the Department of Neonatology of Hunan Children's Hospital from January 2016 to September 2022.According to the prognosis at 12 months of age,the infants were assigned into favourable prognosis group and poor prognosis group.Univariate and binary logistic regression were used to analyze the risk factors for poor prognosis,and the predictive value of anterior horn width(AHW)for adverse prognosis was assessed using receiver operating characteristic(ROC)curves.ResultsA total of 80 term neonates with SIVH were enrolled,including 39 cases in the favourable prognosis group and 41 in the poor prognosis group.In the poor prognosis group,the incidence of neonatal seizures,severe abnormalities in amplitude-integrated electroencephalography and brain white matter injury,age at diagnosis,and AHW value were all significantly higher than those in the favourable prognosis group(P<0.05).Binary logistic regression analysis showed that larger AHW values(OR=1.257,95%CI 1.104-1.431,P=0.001)and brain white matter injury(OR=5.569,95%CI 1.558-19.908,P=0.008)are independent risk factors for poor prognosis in term infants with SIVH(P<0.05).The ROC curve analysis revealed that AHW value≥13.5 mm was indicative of an adverse prognosis in term infants with SIVH,with a sensitivity of 63.4%and specificity of 76.9%.ConclusionsBrain white matter injury and severe ventricular dilation are independent risk factors for poor prognosis of SIVH in term infants.When the AHW value≥13.5 mm,there is a heightened risk of poor prognosis.