Clinical application of noninvasive brain edema monitoring technology in brain edema of neonates with severe asphyxia in plateau area

doi:10.3877/cma.j.issn.1673-5250.2024.01.015

Objective

To explore the clinical application value of the main output parameter of non-invasive dynamic brain edema monitor: disturbance coefficient (DC) in the brain edema of neonates with severe asphyxia in plateau area.

Methods

From December 2019 to June 2023, 22 neonates with severe asphyxia in plateau area treated in neonatal intensive care unit (NICU) of Changdu People′s Hospital in Tibet Autonomous Region were selected as the research objects and included in the severe asphyxia group. Twenty-two cases of non-severe newborns in plateau area who were treated in the neonatal ward of the same hospital in the same period were taken as control group. With prospective research method, non-invasive brain edema dynamic monitoring instrument was used to two groups of neonates for brain edema monitoring. Multivariate unconditional logistic regression analysis was used to determine whether DC value was an independent influencing factor of brain edema in neonates with severe asphyxia in plateau area. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to evaluate the evaluation value of DC value for brain edema in neonates with severe asphyxia. This study was approved by the Medical Ethics Committee of Changdu People′s Hospital (Approval No. 2021006). The guardians of all children had informed consents to the diagnosis and treatment process and signed the informed consent forms of clinical research.

Results

① The DC value of neonates in severe asphyxia group was 32±11, which was lower than that of 56±13 in control group, and the difference was statistically significant (t=-6.82, P<0.001). ② Multivariate unconditional logistic regression analysis showed that DC value increase (OR=0.801, 95%CI: 0.790-0.895, P=0.049) was an independent protective factor for brain edema in neonates with severe asphyxia. ③ The AUC of the DC value of the non-invasive brain edema dynamic monitor for evaluating brain edema in neonates with severe asphyxia was 0.926, the sensitivity was 81.8%, the specificity was 90.9%, and the optimal cut-off value of DC was 45.5.

Conclusions

In plateau areas, DC value of non-invasive brain edema monitoring parameter can help evaluate brain edema in neonates, so as to take timely treatment.

Key words: Asphyxia neonatorum, Brain edema, Intracranial pressure, Altitude, Disturbance coefficient, Root cause analysis, ROC curve, Infant, newborn

表1 2组新生儿临床资料比较

组别	例数	男性[例数(%)]	出生胎龄(d，±s)	入院日龄[d，M(Q₁，Q₃)]	BW(kg，±s)	临床症状及体征[例数(%)]
组别	例数	男性[例数(%)]	出生胎龄(d，±s)	入院日龄[d，M(Q₁，Q₃)]	BW(kg，±s)	意识障碍	惊厥
重度窒息组	22	11(50.0)	264.6±21.2	0.2(0.2，0.6)	2.9±0.8	5(22.7)	7(31.8)
对照组	22	12(54.5)	266.4±19.7	0.5(0.1，0.8)	2.8±0.7	0(0)	0(0)
统计量		χ²＝0.34	t＝0.42	Z＝0.52	t＝1.05	—	—
P值		0.490	0.504	0.456	0.207	0.026^a	0.020^a
组别	例数	临床症状及体征[例数(%)]				实验室检查(±s)
组别	例数	激惹	肌张力异常	拥抱反射增强	拥抱反射减弱	WBC(×10⁹/L)	中性粒细胞百分比(%)
重度窒息组	22	19(86.3)	22(100.0)	6(27.2)	16(72.8)	11.6±5.3	48.7±14.6
对照组	22	0(0)	0(0)	0(0)	1(4.5)	10.6±3.5	46.1±14.7
统计量		—	—	—	—	t＝1.04	t＝1.66
P值		0.002^a	0.001^a	0.013^a	0.003^a	0.303	0.209
组别	例数	实验室检查			DC值	治疗3 d内临床症状及体征消失^b[例数(%)]
组别	例数	Hb(g/L，±s)	PLT(×10⁹/L，±s)	CRP>0.1 g/L[例数(%)]	DC值	治疗3 d内临床症状及体征消失^b[例数(%)]
重度窒息组	22	146.6±34.3	356.6±190.9	6(27.2)	32±11	20(90.9)
对照组	22	144.9±35.2	365.5±137.0	5(22.7)	56±13	1(4.5)
统计量		t＝0.25	t＝－0.29	χ²＝0.20	t＝－6.82	χ²＝5.34
P值		0.807	0.776	0.221	<0.001	0.011

表1 2组新生儿临床资料比较

组别	例数	男性[例数(%)]	出生胎龄(d，±s)	入院日龄[d，M(Q₁，Q₃)]	BW(kg，±s)	临床症状及体征[例数(%)]
组别	例数	男性[例数(%)]	出生胎龄(d，±s)	入院日龄[d，M(Q₁，Q₃)]	BW(kg，±s)	意识障碍	惊厥
重度窒息组	22	11(50.0)	264.6±21.2	0.2(0.2，0.6)	2.9±0.8	5(22.7)	7(31.8)
对照组	22	12(54.5)	266.4±19.7	0.5(0.1，0.8)	2.8±0.7	0(0)	0(0)
统计量		χ²＝0.34	t＝0.42	Z＝0.52	t＝1.05	—	—
P值		0.490	0.504	0.456	0.207	0.026^a	0.020^a
组别	例数	临床症状及体征[例数(%)]				实验室检查(±s)
组别	例数	激惹	肌张力异常	拥抱反射增强	拥抱反射减弱	WBC(×10⁹/L)	中性粒细胞百分比(%)
重度窒息组	22	19(86.3)	22(100.0)	6(27.2)	16(72.8)	11.6±5.3	48.7±14.6
对照组	22	0(0)	0(0)	0(0)	1(4.5)	10.6±3.5	46.1±14.7
统计量		—	—	—	—	t＝1.04	t＝1.66
P值		0.002^a	0.001^a	0.013^a	0.003^a	0.303	0.209
组别	例数	实验室检查			DC值	治疗3 d内临床症状及体征消失^b[例数(%)]
组别	例数	Hb(g/L，±s)	PLT(×10⁹/L，±s)	CRP>0.1 g/L[例数(%)]	DC值	治疗3 d内临床症状及体征消失^b[例数(%)]
重度窒息组	22	146.6±34.3	356.6±190.9	6(27.2)	32±11	20(90.9)
对照组	22	144.9±35.2	365.5±137.0	5(22.7)	56±13	1(4.5)
统计量		t＝0.25	t＝－0.29	χ²＝0.20	t＝－6.82	χ²＝5.34
P值		0.807	0.776	0.221	<0.001	0.011

表2 影响重度窒息新生儿发生脑水肿的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
意识障碍(vs无意识障碍)	7.134	2.857	6.238	0.013	9.781	2.465～10.654
惊厥(vs无惊厥)	6.145	2.022	5.998	0.021	8.879	3.012～12.034
头颅影像学检查结果异常^a(vs无异常)	5.709	2.373	5.786	0.016	10.987	2.878～12.712
DC值(连续变量)	0.551	1.027	3.013	0.049	0.801	0.790～0.895
治疗3 d内临床症状及体征消失^b(vs未消失)	7.452	3.012	6.891	0.010	5.091	2.878～6.789

表2 影响重度窒息新生儿发生脑水肿的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
意识障碍(vs无意识障碍)	7.134	2.857	6.238	0.013	9.781	2.465～10.654
惊厥(vs无惊厥)	6.145	2.022	5.998	0.021	8.879	3.012～12.034
头颅影像学检查结果异常^a(vs无异常)	5.709	2.373	5.786	0.016	10.987	2.878～12.712
DC值(连续变量)	0.551	1.027	3.013	0.049	0.801	0.790～0.895
治疗3 d内临床症状及体征消失^b(vs未消失)	7.452	3.012	6.891	0.010	5.091	2.878～6.789

图1 无创脑水肿动态监护仪DC值评估重度窒息新生儿发生脑水肿的ROC曲线分析注：DC为扰动系数，ROC曲线为受试者工作特征曲线

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