血压变异性联合脑血流参数在预测极低出生体重早产儿脑室内出血的作用

doi:10.3969/j.issn.1006-5725.2023.16.018

Abstract

Abstract:

Objective Hemodynamic instability is the main factor in the development of intraventricular hemorrhage （IVH） in preterm infants. The purpose of this study is to evaluate the predictive value of blood pressure variability （BPV） and anterior cerebral artery （ACA） blood flow parameters in IVH in preterm infants with gestational age ≤ 32 weeks and birth weight ≤ 1 500 g. Methods Preterm infants with gestational age ≤32 weeks and birth weight ≤ 1500 g admitted to the neonatal intensive care unit （NICU） were selected as the research subjects. All preterm infants were admitted within 1 hour after birth， and systolic blood pressure （SBP）， diastolic blood pressure （DBP）， and mean arterial blood pressure （MABP） were monitored every 1 hour interval. The difference between maximum and minimum values （max?min）， standard deviation （SD）， coefficient of variation （CV）， and successive variation （SV） were used as BPV indicators. On the 1st， 3rd， and 7th day of admission， transcranial ultrasound examination was performed to screen for the occurrence of IVH. On the 1st day， systolic velocity （Vs）， diastolic velocity （Vd）， and resistance index （RI） of ACA were measured simultaneously. Preterm infants were divided into IVH group and non IVH group based on the results of transcranial ultrasound examination， and the correlation between BPV indicators， ACA blood flow parameters， and the development of IVH was analyzed. Results A total of 92 preterm infants met the inclusion criteria， including 49 in the IVH group and 43 in the non IVH group. There was no statistically significant difference in baseline characteristics such as gestational age， birth weight， gender， and perinatal medical history between the two groups of preterm infants （P > 0.05）. SBP SD （OR = 1.480 95% CI：1.020 ~ 2.147）， and ACA?RI （OR = 3.027 95% CI： 2.769 ~ 3.591） are independent risk factors for IVH in preterm infants. The sensitivity and specificity of combined detection of SBP SD， and ACA?RI in predicting IVH were 61.2% and 79.1%， respectively. Conclusion High BPV and ACA?RI are related to IVH in preterm infants with gestational age ≤ 32 weeks and birth weight ≤ 1 500 g. Combined detection of SBP SD， and ACA?RI has a certain predictive effect on early identification of IVH.

Key words: preterm infant, intraventricular hemorrhage, blood pressure, blood pressure variability, ACA resistance index, transcranial doppler

CLC Number:

R722

Lijun JIANG,Qian YU,Fudong WANG,Mingfu WU,Zhifeng LIU,Longfeng ZHANG,Libing. ZHANG. The role of blood pressure variability indicators combined with cerebral blood flow parameters in predicting intraventricular hemorrhage in very low birth weight preterm infants[J]. The Journal of Practical Medicine, 2023, 39(16): 2116-2121.

Figures/Tables 6

Tab.1

Tab.2

Tab.3

Fig.1

Fig.2

Fig.3

References 30

1	江苏省新生儿脑损伤规范化诊疗研究协作组.江苏省早产儿脑损伤多中心临床流行病学调查［J］. 临床儿科杂志，2019，37（1）： 6-10.
2	PERLMAN J M. Periventricular-intraventricular hemorrhage in the premature infant- A historical perspective［J］. Semin Perinatol， 2022， 46 （5）： 1-8.
3	CIZMECI M N， DE VRIES L S， LY L G， et al. Periventricular Hemorrhagic Infarction in Very Preterm Infants： Characteristic Sonographic Findings and Association with Neurodevelopmental Outcome at Age 2 Years［J］. J Pediatr， 2020，217（2）：79-85.e1.
4	HWANG-BO S， SEO Y M， OH M Y， et al. The prognosis of refractory hypotension and severe intraventricular hemorrhage in very low birth weight infants［J］. Medicine （Baltimore）， 2022， 101（30）： e29598.
5	LUO J， LUO Y， ZENG H， et al. Research Advances of Germinal Matrix Hemorrhage： An Update Review［J］. Cell Mol Neurobiol， 2019， 39 （1）： 1-10.
6	CHENG B， BALLABH P. Recovery of the brain after intraventricular hemorrhage［J］. Semin Fetal Neonatal Med， 2022， 27 （1）：1-8.
7	VESOULIS Z A， FLOWER A A， ZANELLI S， et al. Blood pressure extremes and severe IVH in preterm Infants［J］. Pediatr Res， 2020， 87（1）： 69-73.
8	LIGHTBURN M H， GAUSS C H， WILLIAMS D K， et al. Observational study of cerebral hemodynamics during dopamine treatment in hypotensive ELBW infants on the first day of life［J］. J Perinatol， 2013， 33（9）： 698-702.
9	PETER D S， GANDY C， HOFFMAN S B. Hypotension and adverseoutcomes in prematurity： comparing definitions［J］. Neonatology， 2017， 111（3）：228-233.
10	DACOSTA C S， CZOSNYKA M， SMIELEWSKI P， et al. Optimalmean arterial blood pressure in extremely preterm infants within thefirst 24 hours of life［J］. J Pediatr，2018， 203（12）：242-248.
11	MIALL-ALLEN V M， DE VRIES L S， WHITELAW A G. Mean arterial blood pressure and neonatal cerebral lesions［J］. Arch Dis Child， 1987， 62（10）：1068-1069.
12	VESOULIS Z A， TERS N M EL， WALLENDORF M， et al. Empirical estimation of the normative blood pressure in infants <28 weeks gestation using a massive data approach［J］. J Perinatol， 2016， 369（4）：291-295.
13	ESCOURROU G， RENESME L， ZANA E， et al. How to assess hemodynamic status in very preterm newborns in the first week of life？［J］. J Perinatol， 2017， 37（9）： 987-993.
14	ZUBROW A B， HULMAN S， KUSHNER H，et al. Determinants of blood pressure in infants admitted to neonatal intensive care units： a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group［J］. J Perinatol， 1995， 15（6）：470-479.
15	PARATI G， STERGIOU G S， DOLAN E， et al. Blood pressure variability： clinical relevance and application［J］. J Clin Hypertens （Greenwich）， 2018， 20（7）：1133-1137.
16	PARATI G， OCHOA J E， LOMBARDI C， et al. Blood pressure variability： assessment， predictive value， and potential as a therapeutic target［J］. Curr Hypertens Rep， 2015， 17（4）：537-555.
17	PAPILE L A， BURSTEIN J， BURSTEIN R， et al. Incidence and evolution of subependymal and intraventricular hemorrhage： a study of infants with birth weights less than 1，500 gm［J］. J Pediatr， 1978， 92（4）：529-534.
18	王彤，柯淑兰，吴轶，等. H型高血压患者血压变异性与同型半胱氨酸及脂联素的相关性［J］. 实用医学杂志，2018，34（19）：3211-3214.
19	DA J， ZHANG Z， SHEN Y， et al. Blood pressure variability is independent of systolic pressure in adolescent and young adult patients undergoing hemodialysis［J］. Pediatr Res， 2018， 83（3）：615-621.
20	GARVEY A A， WALSH B H， INDER T E. Pathogenesis and prevention of intraventricular hemorrhage［J］.Semin Perinatol， 2022， 46（5）： 151592.
21	SOUL J S， HAMMER P E， TSUJI M， et al. Fluctuating pressure-passivity is common in the cerebral circulation of sick premature infants［J］. Pediatric research， 2007， 61 （4）： 467-473.
22	RHEE C J， FRASER C D， KIBLER K， et al. The ontogeny of cerebrovascular pressure autoregulation in premature infants［J］. Acta Neurochir Suppl， 2014， 34（12）： 926-931.
23	AL-AWEEL I， PURSLEY D M， RUBIN L P， et al. Variations in prevalence of hypotension， hypertension， and vasopressor use in NICUs［J］. J Perinatol， 2010， 21（5）： 272-278.
24	BADA H S， KORONES S B， PERRY E H， et al. Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhage［J］. J Pediatr， 1990， 117（4）： 607-614.
25	BEL F V， BOR M V D， STIJNEN T， et al. Aetiological rôle of cerebral blood-flow alterations in development and extension of peri-intraventricular haemorrhage［J］. Dev Med Child Neurol， 1987， 29（5）： 601-614.
26	HUANG X， GUO H， YUAN L， et al. Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status［J］. Ther Adv Neurol Disord， 2021， 14（5）： 1-13.
27	ALTIT G， BHOMBAL S， CHOCK V Y. Cerebral saturation reflects anterior cerebral artery flowparameters by Doppler ultrasound in the extremelypremature newborn［J］. J Perinatol， 2022， 42（2）：1-6.
28	FARAG M M， GOUDA M H， ALMOHSEN A M A， et al. Intraventricular hemorrhage prediction in premature neonates in the era of hemodynamics monitoring： a prospective cohort study［J］. Eur J Pediatr， 2022， 181（12）： 4067-4077.
29	BAIK-SCHNEDITZ N， HOLLER N， URLESBERGER B， et al. Cerebral Doppler Resistance Index （RI） is associated with regional cerebral oxygenation［J］. Acta Paediatr， 2020， 109（11）：2299-2301.
30	ARGOLLO N， LESSA I， RIBEIRO S. Cranial Doppler resistance index measurement in preterm newborns withcerebral white matter lesion［J］. J Pediatr， 2006， 82（3）：221-226.

项目	非IVH组（n = 43）	IVH组（n = 49）	t/χ² 值	P值
胎龄（x ± s，周）	29.4 ± 2.1	28.6 ± 2.4	1.663	0.100
出生体质量（x ± s，g）	1 252.1 ± 230.7	1 158.9 ± 263.1	1.794	0.076
男性	22（51.2）	26（53.1）	0.033	0.856
阴道分娩	20（46.5）	27（55.1）	0.676	0.411
多胎	3（7.0）	6（12.2）	0.247	0.619
有创通气	3（7.0）	9（18.4）	2.620	0.106
产前激素使用	29（67.4）	26（53.1）	1.970	0.160
胎膜早破	12（27.9）	16（32.7）	0.244	0.622
PDA	21（48.8）	33（67.3）	3.236	0.072
PS使用	18（41.9）	26（53.1）	1.151	0.283
早发型败血症	6（14.0）	11（22.4）	1.097	0.295

项目	非IVH组（n = 43）	IVH组（n = 49）	t值	P值
SBP（mmHg）	56.35 ± 4.68	55.78 ± 6.01	0.505	0.615
DBP（mmHg）	28.86 ± 4.71	26.67 ± 5.38	2.061	0.042
MABP（mmHg）	37.09 ± 4.52	34.71 ± 5.75	2.185	0.032
SBP
max?min	21.67 ± 7.32	24.86 ± 6.92	2.142	0.035
SD	5.42 ± 1.59	6.22 ± 1.68	2.335	0.022
CV（%）	9.98 ± 3.05	11.39 ± 3.59	2.015	0.045
SV	8.17 ± 1.25	8.34 ± 1.37	0.609	0.544
DBP
max?min	21.74 ± 7.76	26.43 ± 5.46	3.306	0.001
SD	5.61 ± 1.76	6.70 ± 1.31	3.310	0.001
CV（%）	20.22 ± 8.28	26.06 ± 7.15	3.626	<0.001
SV	7.49 ± 1.17	7.71 ± 1.47	0.810	0.420

[1]	Weiwei HU,Xiaorong LI,Chunhui TIAN,Zhifen LIU,Junqi. YING. Effect of telmisartan combined with calcium dobesilate on hypertensive patients with type 2 diabetes mellitus on the blood pressure rhythm [J]. The Journal of Practical Medicine, 2023, 39(19): 2534-2540.
[2]	CHEN Chun, YANG Chuanzhong, HUANG Zhifeng. . Effect of different cord clamping methods on short ⁃ term outcomes of extremely preterm infants [J]. The Journal of Practical Medicine, 2022, 38(2): 201-205.
[3]	ZHANG Qiaoyun, LI Rui.. Effect of intraoperative blood pressure management on early postoperative acute kidney injury in elderly patients undergoing major abdominal surgery [J]. The Journal of Practical Medicine, 2021, 37(7): 894-898.
[4]	ZHANG Ziqu, LIU Yong, LI Jing⁃ wei, WANG Yali, ZHAI Yujun.. Effect of amlodipine ⁃ benazepril tablets on ambulatory blood pressure of grade 2 essential hypertension patients uncontrolled by free combination of two antihypertensive drugs #br# #br# [J]. The Journal of Practical Medicine, 2021, 37(18): 2375-2379.
[5]	ZHENG Jing, HUANG Kaitao, ZHANG Xiaoqin, XIE Yeli, XU Meifang, YOU Tianhui. . The current status and affecting factors of blood pressure monitoring at home in maintenance hemodialysis patients with hypertension [J]. The Journal of Practical Medicine, 2021, 37(16): 2147-2151.
[6]	ZHANG Sue, CHEN Chun, CHEN Siqi, LIN Yanqing, YANG Chuanzhong.. Impact of latency period after premature rupture of membranes on early outcomes of preterm infants with gestational age＜34 weeks [J]. The Journal of Practical Medicine, 2021, 37(15): 1976-1981.
[7]	ZENG Jiemin, HUANG Ping, LU Gen, TONG Zhijie, WANG Hongying, FENG Haoran.. Relationship between abnormal blood pressure and endothelial disfunction in children after operation on coarctation of aorta [J]. The Journal of Practical Medicine, 2021, 37(14): 1832-1836.
[8]	WU Yan, ZHONG Xiaoyun, GONG Hua, CHEN Wen, ZHANG Xiaoting, ZHAO Xiangqun, LI Mingying.. R722.6 Follow ⁃up study on physical and neurodevelopmental outcomes in extremely preterm infants at corrected age of 6 months [J]. The Journal of Practical Medicine, 2021, 37(11): 1445-1455.

The role of blood pressure variability indicators combined with cerebral blood flow parameters in predicting intraventricular hemorrhage in very low birth weight preterm infants

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 30

Related Articles 8

Recommended Articles

Metrics

Comments