| Research background Approximately 1 million newborns worldwide die from birth asphyxia every year,and asphyxia is the third cause of neonatal death.With the deepening and promotion of neonatal asphyxia resuscitation technology,the success rate of resuscitation has increased significantly,and asphyxia complications have become a threat The main reason for the life of a child.Objective Summarize the characteristics and outcomes of multiple organ injuries based on the collected asphyxia neonatal case data to provide reference for clinical early diagnosis,treatment and prevention of various organ damage,and analyze the influencing factors of multiple organ damage of asphyxia neonates from several aspects such as the condition of pregnant mother and fetus and resuscitation measures,and provide basis for early identification of high-risk neonates with multiple organ damage and actively taking effective measures to correct the influencing factors to decrease the incidence of organ damage of asphyxia neonates,reduce the number of organ damage,and alleviate the severity of organ damage,and further improve the clinical management ability after neonatal asphyxia resuscitation,cut back the mortality rate of asphyxia and improve the quality of life of children with asphyxia.Methods Through medical record system to find out the neonates with asphyxia diagnosed and treated in the Department of Neonatology,Yichang Central People’s Hospital of Hubei Province from 2019.01.01 to 2020.08.31,perform statistical analysis after summarizing the clinical data and evaluate the function of each organ in line with the children’s clinical manifestations and auxiliary examination results,including liver function(alanine aminotransferase),renal function(urine volume,creatinine,urea value),blood gas analysis(carbon dioxide partial pressure,oxygen partial pressure),myocardial enzyme spectrum(serum creatine phosphokinase,myokinase isoenzyme value),craniocerebral ultrasound,cardiac ultrasound,electrocardiogram,cranial nuclear magnetic resonance examination,chest and abdominal X line,to understand the clinical features of asphyxia neonates with organ damage.Computing the number of death to reckon the asphyxia fatality rate and know the major cause of death.Based on gestational age,degree of asphyxia and number of organ damage,these suffocated nowborns were split into premature group,term group and slight suffocation group,and serious suffocation group and multi-organ damage group,non-multi-organ damage group to compare the effect of gestational age and degree of asphyxia on organ damage and the relationship between organ damage and clinical outcome of asphyxia and to analyze and discuss the influence of maternal age,history of previous pregnancy,illness,fetal,placenta,umbilical cord amniotic fluid and mode of resuscitation on multiple organ damage secondary to asphyxia.Enumeration data were expressed in number,percentages and X~2test,p<0.05 showed statistically significant differences.When analyzing the risk factors of multiple organ damage in suffocation,single-factor analysis is firstly conducted,and then logistic regression analysis is performed on the factors that are significantly related to the occurrence of multiple organ damage to evaluate the occurrence of multi-organ damage absolute risk factors.The results were expressed as relative risk(OR)and95%feasible interval,p<0.05 indicated that the difference was statistically significant.All data analysis was performed by SPSS 26 software.Results(1)86.0%of neonatal asphyxia suffer from organ damage,and the neonatal asphyxia with the number of organ damage≥2 account for 62.0%.(2)The incidence of organ injury after neonatal suffocation was lung(62.1%)>heart(46.0%)>brain(38.7%)>kidney(33.6%),gastrointestinal(26.8%)>liver(3.0%).(3)Among all organ injuries,the risk of suffocation in the lung,brain,kidney and gastrointestinal tract of premature infants is significantly increased when compared with term infants,and comparison between groups was statistically significant(p<0.05).the risk of brain,lung and heart injury in children with severe asphyxia is significantly increased compared with mild asphyxia,and comparison between groups was statistically significant(p<0.05).(4)Respiratory failure(54.8%)is most commonpattern of manifestation of asphyxia neonates after lung injury,of which type I and II respiratory failure accounted for 23.7%and 76.3%respectively,followed by NRDS(43.1%),pneumonia(28.1%),MAS(18.5%),PPHN(4.1%),Pneumothorax(2.7%),atelectasis(2.1%)and pneumorrhagia(1.4%).(5)In 235 newborns with asphyxia,225 cases(95.7%)have abnormal increase of creatine kinase isozyme and 103 cases(43.8%)have abnormal electrocardiogram and 45 cases have cardiac ultrasound abnormalitie.but only 48%of children with abnormal increase of creatine kinase isozyme were diagnosed with heart injury,while all children with abnormal electrocardiogram or echocardiography had heart injury.In children with heart injury,abnormal changes of electrocardiogram have ST-segment changes 96 cases(93.2%)and 19 cases(12.6%)have various arrhythmia,the abnormal ultrasound of the heart have tricuspid regurgitation 14 cases(31.1%),right ventricular enlargement 7 cases(15.6%),patent ductus arteriosus 6 cases(13.3%),pericardial effusion 5 cases(11.1%),enlarged left atrium 5cases(11.1%),abnormal atrial shunt 4 cases(8.9%)and weakened ventricular wall motion4cases(8.9%).(6)Among 91 children with brain injury,67 cases(73.6%)were premature babies,of which 36 cases(53.7%)were ICH,16 cases(23.9%)were HIE and 15 cases(22.4%)were both,and 24 cases(26.4%)were full-term infants,of which 15 were HIE(62.5%),4 were ICH(16.7%),and 5 were both(20.8%).(7)Only 18(22.8%)of 79 children with kidney injury had symptoms of anuria or oliguria,while 61(77.2%)had abnormal renal function without obvious clinical symptoms and signs.(8)Among 63 children with gastrointestinal injury,54(85.7%)had abdominal distension,48(76.2%)had gastric retention,35(55.6%)had gastrointestinal bleeding,and 10(15.8%)had neonatal necrotizing enterocolitis.(9)Of the 235children with asphyxia,15 died(including 8 died after giving up treatment≥72 hours after birth).The case fatality rate was 6.3%.There were 11 premature babies among the deaths,accounting for 73.3%.The specific causes of death were analyzed as follows:4 cases of heart failure,2 cases of severe intracranial hemorrhage,3cases of serious PPHN,1 case of pneumothorax,4 cases of respiratory failure.(10)All the children who died had organ damage,of which 14 cases had multiple organ damage,accounting for 93.3%,of which 8 cases had 3types of organ damage(including 4 patients with concurrent heart,lung and brain lesions and1 patients with concurrent heart,lung and gastrointestinal injuries and 2 patients with concurrent heart,lung and kidney injury and 1 patients with concurrent lung,kidney and brain lesions),of which 4 cases had 4 types of organ damage(including 3 patients with concurrent heart,brain,lung and kidney lesions,and 1 patients with concurrent heart,gastrointestinal tract,lung and kidney lesions),of which 2 cases had 5 types of organ damage(including1patients with concurrent heart,brain,lung,kidney and liver lesions,and 1 patients with concurrent heart,brain,lung,kidney and gastrointestinal tract lesions).One case died of single organ injury,which was heart injury and died after the family renounced treatment.There were no deaths among the patients without organ damage.The mortality rate of children with multiple organ damage group was significantly higher than that of non-multi organ damage group,and the difference between the two groups was statistically significant(p<0.05).(11)maternal age≥35 years old or suffering from hypertension during pregnancy,history of threatened abortion,placental abnormalities,preterm birth,severe asphyxia,low birth weight,and resuscitation oxygen concentrations>40%are risk factors for secondary multiple organ damage in asphyxiated newborns,of which preemy,low birth weight infant,and oxygen concentrations for resuscitation>40%are independent risk factors for multiple organ damage.Conclusion(1)Asphyxia is a common and critical illness of newborns.The damage of various organs is the main adverse consequence caused by asphyxia,that is an important cause of neonatal death.The highest incidence of single organ damage is lung,followed by heart and brain,and the damage of the heart and lungs and brain are the main cause of death in asphyxia newborn.(2)Multiple organ damage often occurs after neonatal suffocation,especially in premature infants and children with serious suffocation.(3)The manifestations of multiple organ damage in neonates with asphyxia are varied and it is necessary to draw support from assisted examination with organ function monitoring to identify the organ damage,to improve the early diagnosis rate of multi-organ damage and assist in evaluating the degree of injury.(4)Multiple organ damage significantly increases the risk of death in neonates with suffocation,and the number of organ damage is often≥3 in neonates who die and at least two organs of the heart lung brain are damaged at the same time.(5)The occurrence of multiple organ damage after neonatal asphyxia is positively correlated with premature delivery,low birth weight,severe asphyxia,resuscitation oxygen concentration>40%and placental abnormalities or pregnant mother’s age≥35 years old or suffering from hypertension or early threatened abortion.Among them,premature delivery,low birth weight and oxygen concentration>40%during resuscitation are independent risk factors that cause multiple organ damage in asphyxiated newborns.(6)A timely and effective new method of resuscitation for newborns with asphyxia,active prevention and treatment of high-risk factors of multiple organ damage after asphyxia,familiarity with the clinical features of various organ damage in newborns with asphyxia,strengthening of the monitoring of the function status of each organ,and early diagnosis and treatment of various organ damage can reduce the occurrence and development of multi-organ damage after suffocation,and it is conducive to further reducing the mortality of children with asphyxia. |
PDF Full Text Request