The Clinical Study Of Doppler Ultrasound In Evaluating The Effectiveness Of Mild Hypothermia In The Treatment Of Neonatal Hypoxic-ischemic Encephalopathy And Meta Analysis Of The Coincidence Rate In The Diagnosis Of Neonatal Intracranial Hemorrhage

Objective: To explore the application of Doppler ultrasound in evaluating the effectiveness of Hypothermia therapy in the treatment of neonatal HIE.To assess the accuracy of ultrasonography versus CT in the diagnosis of intracranial hemorrhage in children of China.by meta-analysis.Methods:1.In the first part:A random selection was made of 60 full-term neonates with moderate to severe HIE treated in the Neonatology Department of Tianjin Central Obstetrics and Gynecology Hospital from January 2011 to April 2019.They were divided into Hypothermia therapy group(30 cases)and control group(30 cases).Both groups received symptomatic supportive treatment,including maintaining blood pressure,oxygen saturation,perfusion and blood sugar stability,preventing and treating brain edema and anticonvulsant.The patients in Hypothermia therapy group received systemic Hypothermia therapy treatment for 72 hours within 6 hours after birth.The clinical evaluation and follow-up were carried out at different stages.The evaluation included 20 items of neurobehavioral assessment(NBNA)at 7 and 14 days after birth,the incidence of abnormal a EEG at 24,48 and 72 hours after birth,and ultrasonographic measurements including Vs,Vd,RI and PI at 24,48 and 72 hours after birth.The collected data were analyzed by SPSS 13.0 software.2.In the second part:Literatures about Ultrasonography Versus CT in patients with Intracranial Hemorrhage issued from January 1994 to December 2013 were retrieved and the effects were quantitatively estimated with fixed-effect model and random-effect model by meta-analysis.Results:1.In the first part:(1)There were no significant differences in gestational age,age,birth weight,sex,asphyxia degree and HIE score between Hypothermia therapy group and control group.(2)There was no significant difference in neurological symptoms and signs between the two groups at 6 and 24 hours after birth(P > 0.05).There was significant difference in neurological symptoms and signs between the two groups at 48 and 72 hours after birth(P < 0.05).(3)The scores of NBNA at 14 days in both groups were significantly higher than those at 7 days(P < 0.05),and those in Hypothermia therapy group were significantly higher than those in control group at 14 days after birth(P <0.05).(4)Within 72 hours after birth,the Vs,Vd,RI and PI of middle cerebral artery in children with HIE were measured and analyzed by Doppler ultrasonography.There were no significant differences in the values of Vs,Vd,RI and PI between children with mild,moderate and severe HIE in Hypothermia therapy group and those of children with mild,moderate and severe HIE in control group(P > 0.05).Compared with mild group,the values of Vs,RI and PI increased significantly,while Vd in moderate and severe group decreased significantly(P<0.05).(5)The a EEG monitoring of HIE children within 72 hours after birth and the corresponding analysis of a EEG images at different time points indicate that there is no significant difference in the incidence of abnormal a EEG between the two groups at 24 and 48 hours after birth(P > 0.05),and there also is not a difference in the incidence of abnormal a EEG between the two groups at 72 hours after birth(P>0.05).(6)The Vs values of Hypothermia therapy group were negatively correlated with NBNA scores of 7 and14 days after birth,while the Vs values of control group were not correlated.Vs values could be used as an ultrasound monitoring index to evaluate the effectiveness of Hypothermia therapy in the treatment of HIE;Vd values of both groups were negatively correlated with NBNA scores of 7 and 14 days after birth;RI values of both groups were positively correlated with NBNA scores of 7 and 14 days after birth;PI values of both groups were positively correlated with NBNA scores of 7 and 14 days after birth.2.In the second part:In 14 trials,the diagnose accordance rate between ultrasound and CT is not significant,with the pooled OR 1.00(95% CI 0.29-3.43).Conclusion:1.In the first part:Doppler ultrasound has the same effect as NBNA score and a EEG in evaluating the effectiveness of Hypothermia therapy in children with HIE.It avoids the complexity and subjectivity of NBNA score and reduces the cost compared with a EEG.It can beused as a common monitoring method in clinic.2.In the second part:To some degree,the accuracy of utrasound in the diagnosis of intracranial hemorrhage has basically the same effect in comparing with CT.