Clinical and risk factors analysis of brain injury in very low birth weight infants

Abstract

Objective To investigate the incidence of brain injury and analyze the risk factors in very low birth weight infants(VLBWI), in order to explore methods to improve neurodevelopmental outcome. Methods This was a retrospective study in which we reviewed the incidence of brain injury in 326 VLBWI who admitted to our NICU from October 2007 to September 2014.The differences of general characteristics, high-risk perinatal factors, complications of prematurity and respiratory support in brain injury group(n=132) and no brain injury group(n=194) were analyzed, and Logistic regression was used to analyze the related risk factors. Results In 326 VLBWI, premature brain injury was observed in 132 cases(incidence of 40.49%). Hemorrhagic brain injury was observed in 80 cases(incidence of 24.54%, 80/326), in whom total 66 cases(20.25%, 66/326) with periventricular-intraventricular hemorrhage(PVH-IVH), 41 cases with PVH-IVH gradeⅠ-Ⅱ, 25 cases with PVH-IVH grade Ⅲ-Ⅳ.Non-hemorrhagic brain injury was observed in 52 cases(incidence of 15.95%, 52/326), in whom 46 cases with periventricular leukomalacia(14.11%, 46/326). There were no statistically significant differences in general characteristics except gender differences between the two groups.Further analysis of the 28 factors including high-risk perinatal factors, premature complications and respiratory support between the two groups, showed that there were significant differences in 16 factors including asphyxia, chorioamnionitis, antenatal steroid use, neonatal respiratory distress syndrome, hypoxemia, apnea, pulmonary hemorrhage, patent ductus arteriosus, hypotension, acidosis, hypocapnia, anemia, hyperglycemia, thrombocytopenia, high frequency ventilation and extrauterine growth retardation.Further binary Logistic regression analysis showed that antenatal steroids use was negatively correlated with brain injury, chorioamnionitis, acidosis, and patent ductus arteriosus were positively correlated with brain damage, the relative risks of premature brain injury was 0.108, 7.222, 3.045 and 4.565 respectively. Conclusion The mortality rate and the incidence of brain injury in VLBWI are still high.Chorioamnionitis, acidosis and patent ductus arteriosus are closely associated with premature brain damage.Antenatal steroids can prevent premature brain injury.We should pay much attention to these risk factors in the perinatal management of VLBWI, in order to decrease the incidence of premature brain injury. Key words: Preterm infants; Brain injury; Risk factors