Incidence of brain injuries in premature infants with gestational age ≤ 34 weeks in ten urban hospitals in China

Shanghai Institute for Pediatric Research, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China, .
World Journal of Pediatrics (Impact Factor: 1.05). 12/2012; 9(1). DOI: 10.1007/s12519-012-0395-8
Source: PubMed


There is a large number (1.5 million per year) of premature births in China. It is necessary to obtain the authentic incidences of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL), the common brain injuries, in Chinese premature infants. The present multicenter study aimed to investigate the incidence of brain injuries in premature infants in ten urban hospitals in China.

The research proposal was designed by the Subspecialty Group of Neonatology of Pediatric Society of the Chinese Medical Association. Ten large-scale urban hospitals voluntarily joined the multicenter investigation. All premature infants with a gestational age ≤ 34 weeks in the ten hospitals were subjected to routine cranial ultrasound within three days after birth, and then to repeated ultrasound every 3-7 days till their discharge from the hospital from January 2005 to August 2006. A uniform data collection sheet was designed to record cases of brain injuries.

The incidences of overall IVH and severe IVH were 19.7% (305/1551) and 4.6% (72/1551), respectively with 18.4% (56/305) for grade 1, 58.0% (177/305) for grade 2, 17.7% (54/305) for grade 3 and 5.9% (18/305) for grade 4 in nine hospitals. The incidences of overall PVL and cystic PVL were 5.0% (89/1792) and 0.8% (14/1792) respectively, with 84.3% (75/89) for grade 1, 13.5% (12/89) for grade 2, and 2.2% (2/89) for grade 3 in the ten hospitals. The statistically significant risk factors that might aggravate the severity of IVH were vaginal delivery (OR=1.883, 95% CI: 1.099-3.228, P=0.020) and mechanical ventilation (OR=4.150, 95% CI: 2.384-7.223, P=0.000). The risk factors that might result in the development of cystic PVL was vaginal delivery (OR=21.094, 95% CI: 2.650-167.895, P=0.000).

The investigative report can basically reflect the incidence of brain injuries in premature infants in major big cities of China. Since more than 60% of the Chinese population live in the rural areas of China, it is expected to undertake a further multicenter investigation covering the rural areas in the future.

Download full-text


Available from: Hui-Jin Chen, Mar 11, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Periventricular white matter damage (PWMD) also termed periventricular leucomalacia in the preterm infant is of particular importance because no targeted therapy is presently available. Human umbilical cord mesenchymal stem cells (hUC-MSCs) have been studied in a variety of adult brain injury-related neurological disorders. Our aim was to determine whether hUC-MSC transplantation improves glial cell function in cerebral white matter and long-term behavioral function in a PWMD rat model. Rats on postnatal day (P) 3 underwent a permanent ligation of the left common carotid artery followed by 6% O2 for 4 h. Immediately after the hypoxic-ischemic (HI), rats received a single intraperitoneal injection of hUC-MSCs, which were co-cultured with 5-bromodeoxyuridine (BrdU). BrdU+ cells in the brain were tested 24 h after transplantation. Second, rats received hUC-MSC treatment once a day for 3 consecutive days. Glial cells (oligodendrocytes, astrocytes and microglia) were examined on 7 and 18 days post-HI, and behavioral outcomes were tested 27 days post-HI. Significantly, hUC-MSCs migrated mainly into the injured hemisphere. In addition, hUC-MSC treatment improved the long-term functional outcomes of rats, increased mature oligodendrocyte counts, and decreased the number of reactive astrocytes and activated microglia quantities after HI-induced damage in the premature brain. These results suggest that hUC-MSCs can pass through the blood-brain barrier and migrate towards the lesion site to improve brain damage. Therefore, hUC-MSCs have the potential to be utilized as a novel therapeutic strategy for PWMD.
    No preview · Article · May 2014 · Brain research
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The objective of this study is to identify possible perinatal risk factors related to intraventricular hemorrhage (IVH) in preterm infants born at 34 weeks of gestation or less following preterm premature rupture of membranes (pPROM). Methods: A total of 292 preterm infants born at 34 weeks of gestation or less following pPROM were enrolled in the study, while 155 newborns with incomplete data, especially those that lack histological examination of the placenta, maternal details, and neonatal characteristics, have been further excluded. Finally, data of 137 preterm infants were included in the analysis. All infants underwent ultrasonographic screening for IVH. Thirty-three infants with IVH were considered as cases and 104 infants without IVH were considered as controls. The association between risk factors and IVH was evaluated by univariate and multivariate logistic regression analyses. Results: The incidence of IVH in preterm infants born at 34 weeks of gestation or less following pPROM was 24.1%, while the incidence of maternal chorioamnionitis was 43.8%. By univariate analysis, gestational age, birth weight, asphyxia resuscitation, maternal chorioamnionitis, fetal distress, amniotic fluid index, and latency of the rupture of membranes to birth were found to be significantly different between the 2 groups. By logistic regression analysis, lower gestational age, low birth weight, asphyxia resuscitation, and maternal chorioamnionitis were found to be independent risk factors for IVH. Conclusion: Lower gestational age, low birth weight, asphyxia resuscitation, and maternal chorioamnionitis are independent risk factors for IVH in preterm infants born at 34 weeks of gestation or less following pPROM.
    No preview · Article · Jan 2016 · Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association