Analysis Of Clinical Characteristics Of Neonatal Encephalopathy

Objective: To evaluate the risk factors for neonatal encephalopathy( NE) in infants with gestational age >34weeks and access their clinical characteristics,to provide evidence for prevention and control of NE.Methods:Make the questionaire about infants followed up in the out patient department of neonatology in Children’s Hospital affiliated to Chongqing Medical University from November 2011 to May 2013, the clinical data which including maternal and neonatal information and clinical test results were reviewed retrospectively. We divided the infants who were performed two or more NBNA score and(or) DQ score into three groups:Confirmed group(174 cases),suspected group(152 cases) and control group(279 cases). Using SPSS version 20.0. for data analysis and P value ≤0.05 was considered statistically significant.Results:1.(1)The primary reason for the 1405 neonates >34weeks’ gestation coming to hospital is brain injury.1038 cases were term infants,1291 cases(92%)were singleton, The average gestational age was 38.27±1.96 weeks,the average birth weight was 3027.28±627.38 g.the infection rate in neonate period is 52.8%,pneumonia is the major type and there was no case infected in the nervous system.(2)153 cases were the older mother( ≥35years)and the most common complications were infection,gestational diabetes,hypertensive disorder and vaginal hemorrhage,but the proportion was not high.Moreover,the cesarean section rate was high(64.7%).2.(1) Single factor analysis indicated that there were significant different in maternal age ≥35 、 having hypertensive disorder during gestation、bleeding in late pregnancy、premature rupture of membrane lasting over 24 hours、preterm infant(<37w)、low birth weight(<2500g)、multiple pregnancy、postnatal infection、the feeding patterns 、1min Apagr score ≤3points、5min Apgar score ≤7points、and head circumference within one month of age or corrected age between confirm group and control group(P<0.05).Complicating hypertensive disorder during gestation、preterm infant(<37w)、low birth weight(<2500g)、postnatal infection were significantly different between the confirmed group and the suspected group.(2)In multi-factor analysis, when taking the control group as reference group and making comparisons between confirmed group and control group,gestational age <37w、5min Apgar score ≤7points and the lower head circumference within one month of age or corrected age were risk factors of NE. Breast feeding was the protective factor from NE. Taking the suspected group as reference group and making comparisons,no risk factors that related with short outcome of NE.(3)The frequently-used examination were ultrasound,head CT and MRI,There is a significant difference among the three groups in the abnormal detection of MRI. In addition,compared with control group, the specificity of hemorrhage which used CT and abnormal signal change detected by MRI in conformed groups have significant difference(P<0.05).(4)The three groups missing the most points in behavioral ability. In addition,there was a significant difference in the missing points of behavioral ability, active and passive muscle tension muscle tone between confirmed group and control group(P=0.05).There is no difference among three groups in fine motor for DQ scores(P =0.075).The acquired points on gross motor,ability to adapt, language and social behavior in confirmed group significantly higher than control group(P<0.05),respectively.Conclusions:For the neonates,especially for those with high risk factors who were premature,suffering perinatal asphyxia,undergoing infection and with jaundice,we should pay more attention to their neurodevelopment,followed by NBNA score and DQ score regularly,took MRI or EEG examzation if necessary.Early detection and timely treatment may improve the long outcome and prevent the permanent neurologic disorders.