| Objective: The expression levels of plasma S100 B protein and neuron specific enolase(NSE)in preterm infants were measured in the early postnatal period to explore their relationship with brain injury and neurological outcome at discharge,and to analyze their possible risk factors,so as to provide a reference for the early prevention and treatment of brain injury and adverse neurological outcome in preterm infants.Methods:1.Premature infants who were admitted to the department of neonatology of Affiliated Hospital of Guilin Medical College within 24 hours after birth from March 1,2021 to December 1,2022 were selected as the study subjects,and were divided into brain injury group and non-brain injury group(control group)according to clinical symptoms and medical imaging performance findings,the neurological outcome at discharge was divided into normal NBNA score group(more than or equal 35 points)and abnormal NBNA score group(less than 35 points)according to the neonatal behavioral neurological assessment(NBNA),clinical data of the study subjects were collected for analyzing the risk factors of brain injury in premature infants.2.The expression levels of plasma S100 B protein and NSE were measured by enzyme linked immunosorbent assay(ELISA)at 24 hours,72 hours and 1 week after birth,and the differences between the brain injury group and non-brain injury group were compared and analyzed,the differences of expression levels of plasma S100 B protein and NSE at the above three time points were also analyzed between the abnormal and normal NBNA scores group of the brain injury group and the non-brain injury group at discharge.3.The ability of S100 B protein and NSE expression levels to predict brain injury in preterm infants was assessed by the receiver operating characteristic curve(ROC),and logistic regression combined with the ROC curve was used to construct a predictive model for abnormal neurological outcome at discharge of preterm brain injury.Results:1.Gestational age at birth,birth weight,postnatal Apgar score,maternal chorioamnitis or other invasive infections,hyperlactemia,coagulopathy,mechanical ventilation and critical illness scores in admission were statistically significant between the brain injury group and the non-brain injury group(P <0.05).2.The expression levels of plasma S100 B protein and NSE in the brain injury group were(952.10±143.81)pg/m L,(648.43±163.05)pg/m L,(528.82±123.70)pg/m L,(67.29±19.90)ng/m L,(41.00±11.28)ng/m L,(34.83±10.53)ng/m L at 24 hours,72 hours and 1 week respectively were higher than those in the non-brain injury group,and the expression levels of S100 B protein and NSE at three time points of the brain injury group when abnormal neurological outcome was found were(1076.18±76.90)pg/m L,(794.79±119.80)pg/m L,(584.10±112.14)pg/m L,(83.93±13.36)ng/m L,(50.90±7.22)ng/m L and(43.78±7.19)ng/m L respectively,which was significantly higher than the non-brain injury group(P < 0.05).However,the brain injury group when the neurological outcome was normal,the expression level of NSE at 1 week after birth was(29.27±8.19)ng/m L compared with the non-brain injury group(29.21±3.69)ng/m L,the differences of them don’t have statistically significant(P > 0.05).3.The areas under ROC curve for predicting brain injury in preterm infants of the expression levels of plasma S100 B protein at 24 hours,72 hours and 1 week after birth were 0.92,0.77 and 0.71 respectively and the optimal critical values were 725.66 pg/m L,567.25 pg/m L and 516.65 pg/m L respectively,the sensitivity was 94.40%,72.90%,52.30%,and the specificity was 99.20%,74.40%,78.50% respectively.The areas under ROC curve for predicting brain injury in preterm infants of the expression levels of plasma NSE at the above three time points were 0.92,0.82 and 0.66,and the optimal critical values were 50.62 ng/m L,38.36 ng/m L and 35.02 ng/m L respectively,the sensitivity was 82.20%,66.40%,54.20% and the specificity was 97.50%,90.90%,94.20% respectively.4.The expression levels of plasma S100 B protein and NSE at three time points were negatively correlated with neurological outcomes at discharge of premature infants with brain injury(r of S100 B at three time points were 0.59,0.57,0.37 respectively,r of NSE at three time points were 0.62,0.59 and 0.55 respectively,P < 0.05).5.Hyperlactemia which blood lactic acid more than 2 mmol/L(P=0.016,OR=2.46,95%CI:1.19-5.09),and blood lactic acid more than 5 mmol/L(P=0.005,OR=8.12,95%CI: 1.91-34.62),mechanical ventilation(P=0.010,OR=3.83,95%CI: 1.38-10.64),maternal chorioamnitis or other invasive infections(P=0.018,OR=2.56,95%CI: 1.18-5.09)were independent risk factors for brain injury in premature infants.6.The areas under ROC curve of the independent risk factors of brain injury,the expression levels of S100 B protein(pg/m L)and NSE(ng/m L)at 24 hours after birth independently predicted the abnormal neurological outcome of premature infants with brain injury at discharge were 0.56,0.71,0.62,0.97 and0.97 respectively.The area under ROC curve predicted by multiple indexes was0.98,the sensitivity was 95.10%,and the specificity was 89.80%.Conclusions:1.The higher the plasma S100 B protein and NSE expression levels in the early postnatal period,especially at 24 hours after birth,the higher risk of occuring brain injury in preterm infants and abnormal NBNA scores at discharge,which is important reference for the early diagnosis of brain injury in preterm infants.2.When plasma S100 B protein expression was greater than 725.66 pg/m L and plasma NSE expression was greater than 50.62 ng/m L at 24 hours postnatally,the risk of developing brain injury of preterm infants was increased.3.Hyperlactemia,mechanical ventilation and maternal chorioamnitis or other invasive infections are independent risk factors for brain injury in preterm infants. |
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