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The Study on the Prognosis Effect on Early Intervene in Neonatal Hypoxic-ischemic Encephalopathy at Different Time Window

Author: WangJinYuan
Tutor: XiaoXuWu
School: Dalian Medical University
Course: Pediatrics
Keywords: time window therapy hypoxic-ischemic encephalopathy (HIE) prognosis neonate
CLC: R722.1
Type: Master's thesis
Year: 2008
Downloads: 76
Quote: 1
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Abstract


Early therapy for hypoxic-ischemic encephalopathy, HIE can prevent neuron energy metabolism disturbance from continuing aggravation and reperfusion injury; thereby it can relieve or avoid neurological sequela. However, there are few researches in clinic on the effect and degree which is caused by the early therapy for HIE at different time window. There are researches show that there are twice energy failure exist in the process of HIE occurring. Especially for the delayed energy failure, which can cause a serious of biochemical cascade reflect“Waterfall”, and bring or aggravate final neurons death. Therefore, the therapy for HIE is primary aim at the secondary brain injury stage. The latency between the twice energy failure is what we called therapy“time window”, which is also the best time that nerve protection measures to relieve brain injury can be succeed in applying. There are reports from the international world: the therapy“time window”maybe 6 to 15 hours on animal models, and about 6 hours for neonate.Objective: Through discussing the significant differences on nerve system prognosis which is caused by therapy the neonatal HIE at different time window, this study paper advanced the concept of best time window in intervention therapy for neonatal HIE, and also supply the clinical and theory warranty for the therapy time on reducing HIE nerve system sequela in clinic.Objects and methods: Retrospective analyzing the 131 inpatients with moderate HIE in my hospital neonatal department from May 2002 to November 2007, I put them into control group and experimental group according to the time they visited our hospital. There are 32 babies in the control group, and they came to hospital from 24 to 72 hours after they are born. There are 99 babies in the experimental group, and I put them into 3 subgroups (group I, group II and group III) according to the time they visited hospital. There are 33 babies in group I, which are less than 6 hours old; and 35 babies in group II, which are 6 to 12 hours old; 31 babies in group III, which are 12 to 24 hours old. There is no significant difference in basic situation among these inpatients. Each group accepts the same intervention therapy after they are in hospital. All the inpatients make the examination and evaluation in the clinic of children health care when they are 3 months and 6 months old by China standardization Child Development Center of China (CDCC) which include 121 items in the Intelligence Scale and 61 items in the Motion Scale. The evaluation comes from the Mental Development Index (MDI) and Psycho motive Development Index (PDI).Results: The comparison with all the groups in MDI:①group I, group II and group III compared with the control group respectively. There is significant difference in MDI (P<0.01) by compared between group I and control group when the inpatients are 3 months and 6 months old; and there is no significant difference in MDI (P>0.05) by compared between group II , group III and the control group when the inpatients are 3 months and 6 months old.②There is significant difference in MDI (P<0.05) by compared between group I and group II when the inpatients are 3 months and 6 months old.③There is significant difference in MDI (P<0.01) by compared between group I and group III when the inpatients are 3 months and 6 months old.④There is no significant difference in MDI (P>0.05) by compared between group II and group III when the inpatients are 3 months and 6 months old.2, The comparison with all the groups in PDI:①group I, group II and group III compared with the control group respectively. There is significant difference in PDI (P<0.01) by compared between group I and control group when the inpatients are 3 months and 6 months old; and there is no significant difference in PDI (P>0.05) by compared between group II , group III and the control group when the inpatients are 3 months and 6 months old.②There is significant difference in PDI (P<0.05) by compared between group I and group II when the inpatients are 3 months and 6 months old.③There is significant difference in PDI (P<0.01) by compared between group I and group III when the inpatients are 3 months and 6 months old.④There is no significant difference in PDI (P>0.05) by compared between group II and group III when the inpatients are 3 months and 6 months old. Conclusion: 1.There is significant difference in the prognosis effect for the beginning of HIE therapy in different time window. The prognosis effect for the beginning of neonatal HIE therapy within 6 hours is better than that after 6 hours. It is reasonable to suggest that the best time window for HIE therapy in clinical maybe within 6 hours; therefore the significant influence can be caused by starting the therapy later than the time.2.Even though the HIE patient have missed the best therapy time window, it is still better for the therapy as early as possible.

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CLC: > Medicine, health > Pediatrics > Newborns, premature children disease > Neonatal disease
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