| Hypoxic-iischemic brain damage ( HIBD) in neonates is due to perinatal asphyxia. It can not only lead to the death of neonates but also is one of the frequent causes to leave sequelae of nerve system. However, it's difficult to accuratelly predict the clinical outcomes of HIBD. With MRI applied to the clinical practice extensively, it has become easier to evaluate and diagnose the HIBD. Our present study is to elucidate the difference between preterm infants and term neonates with HIBD, find the relationship between the maturation of brain, blood biochemical indexes and factors during perinatal period, and compare these findings with the clinical evaluation.Materials and Methods108 newborn infants with HIBD were selected, including preterm infants (n = 17) and term neonates (n =91). The subjects were between the ages of 10 minutes and seven days all appropriated for their gestational age. The term neonates were divided into three groups, the mild (n =28) , moderate (n =56) and severe (n = 13) group, basedon their clinical symptoms. They were scaned by MRI at the age from 4 days to 10 days after birth. We observed and evaluated brain edema , brain parenchymal hemorrhage, basal ganglia and thalamus, sub-arachnoid hemorrhage and intraventricular hemorrhage. Find the differences between the mild, moderate, severe group and preterm infants.After they entered the hospital, we examined the blood gas analysis and the creatine phosphokinase in every neonates. Detect the differences between groups and elucidate the relationship between perinatal factors, classifications of HIBD and the patterns of MRI.ResultThe rates of extensive brain edema was significantly lower in the mild group than in the moderate group. Subarachnoid hemorrhage and introventricular hemorrhage could be seen more frequently in the severe group than in the moderate group ( p < 0. 05 ). Brain parenchymal hemmorrhage, mainly in the white matter, could be found in each group of term HIBD. The blood creatine phosphokinase and cord PH in the moderate and severe group was significantly higher than in the mild group ( p < 0.05 ).As to the relationship between perinatal factors, groups of HIBD and neonates with low Apgar scores at 5 minutes suffered from severe HIBD much more frequently than those with high Apgar scores at 5 minutes ( p < 0.05 ). HIBD caused by asphyxia in uterus was significantly more severe than that caused by asphyxia during perinatal period ( p < 0. 05 ). The injury of basal ganglia and thalamus was morecommon in the neonates with low Apgar scores (27. 3%) than in those with high Apgar scores (25. 3% ) , but the difference was not significant. The morbidity of the damage in basal ganglia and thalamus in term neonates (27. 5%) was more than that in preterm neonates (11.8%), but the difference was not significant.DiscussionIt is very important to identify and intervene neonatal HIBD as early as possible in order to reduce the morbidity and mortality.The present study of MRI, demonstrated the rates of the brain parenchyma! hemorrhage wasnt significant in the mild, moderate and severe group. Its suggested that extensive brain edema and the damage in basal ganglia and thalamus, especially the latter, was the symbol of severe brain damage, since the morbidity was significant higher in the moderate and severe group than in the mild group. The extensive brain edema reflected the severity of HIBD, functions as the symbol of severe brain damage during the first week after birth and was associated with the direct damage of brain tissue caused by impaired vascular regulation and brain metabolism under hypoxic and/or ischemic state. Brain parenchyma! hemorrhage in term HIBD was mainly focused on the deep white matter; Injury of basal ganglia and thalamus was mostly seen in term neonates, however, under severe hypoxic and ischemic state, it could also be seen in preterm neonates.Under hypoxic state, glycolysis increased by 5 - 10 times. And by producing and accumulating large amount of lactate, acidosis develope... |
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