Analysis of the risk factors of white matter damage in preterm infants
Objective To investigate the risk factors of white matter damage(WMD)in premature infants,especially intraventricular hemorrhage(IVH).Methods This retrospective study included 639 premature infants admitted to the neonatal intensive care unit of Shanxi Children's Hospital from June 2022 to June 2023.The premature infants were divided into WMD group(145 cases)and control group(494 cases)according to the results of head MRI.Univariate analysis and multivariate logistic regression analysis were used to explore the risk factors for WMD in premature infants.Results There were no significant differences in gender,gestational age,fetal distress,cesarean section,asphyxia,Apgar 1 min,umbilical artery pH,maternal age,number of pregnancy,infants of assisted reproductive technology,gestational hypertension,gestational diabetes mellitus,acute chorioamnionitis and prelabor rupture of membranes between the two groups(all P＞0.05).Compared the WMD group with the control group,birth weight[(1 571±611)g vs(1 438±489)g,t=-2.393],umbilical artery base excess[-5.9(-8.2,-3.9)mmol/L vs-5.3(-7.2,-3.5)mmol/L,Z=-2.538],umbilical artery lactate[3.7(2.4,5.3)mmol/L vs 2.8(2.0,4.1)mmol/L,Z=-4.607],sepsis(28.5％vs 15.6％,x2=12.280),patent ductus arteriosus(82.6％vs 74.7％,x2=3.911),hypocarbia(57.2％vs 45.0％,x2=6.696),invasive ventilation(75.9％vs 53.0％,x2=24.010),multifetal pregnancy(19.3％vs 30.6％,x2=7.111),antenatal corticosteroids(51.0％vs 61.9％,x2=5.451),lowest PaCO2value[(28.4±6.7)mmHg vs(31.4±8.0)mmHg,t=4.471]were different significantly(all P＜0.05).There was significant difference in the distribution of IVH between the two groups(x2=40.015,P＜0.01)and multiple comparisons showed that the proportion of grade Ⅲ-Ⅳ IVH in the WMD group was higher than that in the control group(P＜0.05).Multiple logistic regression analysis showed that umbilical artery lactate,grade Ⅲ-Ⅳ IVH,sepsis and invasive ventilation were high risk factors of WMD,and multifetal pregnancy was protective factor of WMD,with OR(95％CI)1.121(1.023,1.228),11.435(3.925,33.314),1.758(1.064,2.904),1.640(1.004,2.680),and 0.587(0.358,0.962),respectively.Conclusions Umbilical artery lactate,grade Ⅲ-Ⅳ IVH,sepsis,and invasive ventilation are independent risk factors for WMD.
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