新生儿症状性低血糖脑损伤相关因素分析

 目的 探讨新生儿低血糖脑损伤的相关高危因素。方法 根据Volpe JJ新生儿神经病学低血糖和低血糖脑损伤诊断标准回顾分析复旦大学附属儿科医院2006年1月1日至2008年12月31日符合标准的13例症状性低血糖脑损伤患儿（脑损伤组）和20例低血糖无脑损伤（无脑损伤组）患儿的病例资料，并对低血糖程度、持续时间和母亲妊高症、患儿性别、胎龄、小于胎龄儿（SGA）、5 min Apgar评分、新生儿惊厥和开奶时间等进行单因素和多因素Logistics分析，探讨发生低血糖脑损伤的相关危险因素。结果 两组在出生体重、胎龄、母亲妊高症、糖尿病母亲婴儿和小于胎龄儿（SGA）比例等方面相当，具有可比性；脑损伤组严重低血糖（<1.5 mmol/dL）明显多于无脑损伤组（61% vs. 10%，P=0.01），另外脑损伤组在低血糖持续时间、5 min Apgar评分小于5分（23% vs. 10%，P<0.05）、新生儿惊厥（38% vs. 5%，P<0.01）和开奶时间延迟>24 h（38% vs. 10%，P<0.05）等方面均明显多于无脑损伤组，与无脑损伤组比较差异显著。结论 新生儿严重长时间低血糖可以导致脑损伤，其他围产期因素如围产期窒息缺氧、新生儿惊厥发作和开奶时间延迟等常可以加重或促进新生儿低血糖脑损伤发生，建议对新生儿低血糖严重程度结合伴发因素采用分级（度）处理的办法，避免低血糖脑损伤的发生。

Associated factors in neonatal symptomatic hypoglycemic brain injury

Objective To investigate the associated factors which are important for the occurrence of neural damage in neonatal symptomatic hypoglycemia. Methods Thirty-three patients with neonatal symptomatic hypoglycemia were studied through a review of their medical records in neonatal intensive care unit (NICU) from Jan 1, 2006 to Dec 31, 2008. The patients were classified into two main groups: hypoglycemic brain injury group (HBI, n=13) and non-hypoglycemic brain injury group (NHBI, n=20). Results The median gestational age was 37 weeks in HBI group and 37.5 weeks in NHBI group. The gestation age, birth weight, pregnancy induced hypertension (PIH), infant of diabetes mother (IDM) and the frequency of small for gestational age (SGA) were similar in both groups. Blood glucose level less than 1.5 mmol/L were more frequent in HBI group (61%) than in NHBI group (10%) (P<0.01). Duration of hypoglycemia was longer in HBI group (median, 14 h) than in NHBI group (median, 6.5 h) (P<0.001). The following factors were more frequent in HBI group than in NHBI group: an Apgar score of less than 5 at 5 min (23% and 10%, P<0.05), neonatal seizure (38% and 5%, P<0.01) and delayed initiation of enteral feeding (38% and 10%, P<0.05). Conclusions This study indicates that severe and prolonged neonatal symptomatic hypoglycemia can cause cerebral lesions and other perinatal risk factors, such as asphyxia/hypoxia, neonatal seizure and delayed enteral feeding, which would exacerbate hypoglycemic brain injuries. Therefore, diseases staging approach is recommended in management of neonatal symptomatic hypoglycemia.