Ultrasound Evaluation Of Neonatal Germinal Matrix-intraventricular Hemorrhage And Analysis Of Its Risk Factors

Objective:the purpose of this study is to use ultrasound as a means of examination to explore the value of ultrasound evaluation in neonatal germinal matrix-intraventricular hemorrhage(GM-IVH),and to further analyze the risk factors of neonatal GM-IVH,and the cut-off point of increased risk of GM-IVH was studied.In order to to provide certain reference for the prevention and early diagnosis of GM-IVH and the reduction of brain injury caused by GM-IVH.Methods:1、 235 newborns who underwent cranial ultrasound scan from January 2019 to October 2020 were collected as the research objects.the newborns came from the neonatal department and neonatal intensive care unit of Affiliated Hospital of Guizhou Medical University.all the newborns completed the first cranial ultrasound examination within one week after birth,they were followed up by cranial ultrasound every 1-2 weeks until they discharged from hospital.according to the follow-up results of cranial ultrasound before discharge,the newborns were divided into case group(GM-IVH group)and control group(no GM-IVH group).2、at the same time,clinical data of parturients and newborns which may affect the occurrence of GM-IVH were collected.data of parturients: delivery age ≥ 35 years,multiple pregnancies,in vitro fertilization-embryo transfer,hypertensive disorder complicating pregnancy,pregnancy complicated with diabetes mellitus,prenatal use of corticosteroids,cervical infection or uterine infection,premature rupture of membranes.data of newborns : sex,birth gestational age,birth weight,mode of delivery,placental abnormalities,oligohydramnios or amniotic fluid contamination,umbilical cord around neck or umbilical cord torsion,1-minute Apgar score,neonatal respiratory distress syndrome(NRDS),bronchopulmonary dysplasia(BPD),intrauterine infectious pneumonia,apnea,pneumothorax,shock,sepsis,suppurative meningitis,coagulation dysfunction,diffuse intravascular coagulation(DIC),anemia,mechanical ventilation,arterial blood gas value and blood glucose value for the first time after admission.3、t-test,Mann Whitney U test and chi-square test were applied to compare the variables between GM-IVH groups and no GM-IVH groups.univariate logistic regression was applied for groups analysis.chi-square trend test was applied to explore the trend of severe GM-IVH.the independent risk factors of GM-IVH were analyzed by Forward stepwise Logistic regression.ROC curve was applied to evaluate the predictive value of risk factors.Results:1、Results of the cranial ultrasound examinationcompared with the first cranial ultrasound examination,the follow-up cranial ultrasound showed that the proportion of grade II,grade III,and grade IV GM-IVH increased.there were 17 cases of neonatal GM-IVH have progressed.9 cases progressed from mild to severe hemorrhage,of which 7 cases progressed to grade III GM-IVH,and 2 cases progressed to grade IV GM-IVH;1 case developed from grade III GM-IVH to grade IV GM-IVH;3 cases developed from negative first cranial ultrasound to grade III GM-IVH;4 cases developed from negative first cranial ultrasound to grade II GM-IVH.2、Univariate analysis of GM-IVHanalysis of counting data: the incidence of cervical infection or uterine infection and incidence of premature rupture of membranes in GM-IVH group were significantly higher than in no GM-IVH group(P<0.05).the incidence of vaginal delivery,neonatal respiratory distress syndrome(NRDS),bronchopulmonary dysplasia(BPD),apnea,shock,sepsis,coagulation dysfunction,diffuse intravascular coagulation((DIC)),anemia and mechanical ventilation in GM-IVH group were significantly higher than that in no GM-IVH group(P<0.05).analysis of quantitative data: the gestational age,birth weight,1-minute Apgar score and arterial blood gas PH value in the GM-IVH group were significantly lower than in no GM-IVH group(P<0.05).taking gestational age ≥ 37 weeks as reference,gestational age <32 weeks increased the risk of GM-IVH(P<0.05).with the decrease of gestational age,there was an increasing trend of severe GM-IVH(P<0.05).taking birth weight ≥2500g as reference,birth weight <1500g increased the risk of GM-IVH(P<0.05).with the decrease of birth weight,there was an increasing trend of severe GM-IVH(P<0.05).taking 1-minute Apgar score 8～10 points as reference,1-minute Apgar score ≤7 points increased the risk of GM-IVH(P<0.05).with the decrease of 1-minute Apgar score,there was not an increasing trend of severe GM-IVH(P>0.05).taking the PH ≥ 7.35 as reference,PH<7.20 increased the risk of GM-IVH(P<0.05).with the decrease of PH value,there was not an increasing trend of severe GM-IVH(P>0.05).3、Multivariate logistic regression analysis of GM-IVHmultivariate logistic regression showed that birth gestational age < 32 weeks,1-minute Apgar score ≤7 points,vaginal delivery and mechanical ventilation were independent risk factors of neonatal GM-IVH.4、Evaluation of ROC curve for predicting GM-IVH of risk factorsbirth gestational age,1-minute Apgar score,vaginal delivery and mechanical ventilation all have certain predictive value for GM-IVH,the combination of risk factors can improve the accuracy of predicting GM-IVH.Conclusion:1、Ultrasound can dynamically observe the development of GM-IVH in a short time,which is an important examination method for the diagnosis and follow-up of neonatal GM-IVH.2、Birth gestational age < 32 weeks,1-minute Apgar score ≤ 7,vaginal delivery and mechanical ventilation are independent risk factors of neonatal GM-IVH.the combination of risk factors can improve the accuracy of predicting GM-IVH.comprehensive prevention of neonatal GM-IVH should be taken in order to reduce the brain injury caused by GM-IVH.