Method of predicting formation of occlusive post-haemorrhagic hydrocephalus in premature babies with extremely low body weight at birth

FIELD: medicine.

SUBSTANCE: in a premature baby the concentration of neuron-specific enolase (NSE), concentration of a brain-derived neurotrophic factor (BDNF), concentration of a vascular-endothelial growth factor (VEGF) in umbilical blood and concentration of the vascular-endothelial growth factor (VEGF) in peripheral blood are determined on the basis of the enzyme immunoassay of umbilical and peripheral blood serum on the 7-th day of life, a prognostic index (PI) is calculated by formula: PI=-0.007×X1+0.006×X2-0.05×X3+0.0004×X4-3.9, where X1 is VEGF content in umbilical blood at birth (ng/ml); X2 is VEGF content in peripheral blood on the 7-th day of life (ng/ml); X3 is NSE content in umbilical blood (mcg/l); X4 is BDNF content in umbilical blood (ng/ml); Const=-3.9. When PI is higher than 0, a conclusion about the absence of risk of occlusive posthaemorrhagic hydrocephalus formation is made, and if PI is lower than 0, a high risk of the said pathology development is predicted.

EFFECT: invention makes it possible to increase the efficiency of prediction of occlusive posthaemorrhagic hydrocephalus formation in the premature children with an extremely low body weight at birth.

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Scope: the present invention relates to the field of medicine, namely to neonatology and Pediatrics.

The level of technology

Miscarriage and premature birth of children is currently one of the most important public health problems worldwide. Despite the impressive success of Perinatology, the frequency of CNS lesions in children are decreasing slightly. Therefore the main goal of midwifery services is the prevention and timely elimination of hypoxic States of the fetus and newborn [1].

Intraventricular hemorrhage (ivh) are the most severe and frequent brain damage in preterm infants. They lead to fatal outcomes and development of a wide range of neuropsychiatric disorders in childhood. Half of premature babies develop intracranial hemorrhage III-IV degree, which in 50-60% of cases are complicated by hydrocephalus, followed by secondary brain damage.

In newborns with extremely low birth weight (ELBW) neonates at birth, bleeding in the ventricles of the brain and germinal matrix are registered in 42-90% of observations. These types of hemorrhages to 50% of cases occur in the first days of life.

Posthemorrhagic hydrocephalus in premature infants manifests in the third week�Le life. At this age because of heavy vital disorders, low body weight and a large amount of blood in the cerebrospinal fluid conducting shunt surgeries impossible. Therefore, at this stage the widely used methods of temporary relief of hydrocephalus: conservative (dehydration) therapy, puncture (ventricular and/or lumbar), external drainage, subcutaneous reservoirs of ventricular-subgaleal drainage. And the frequency and severity of ivh is inversely proportional to gestational age. According to the literature the frequency of adverse neurological outcome in severe hemorrhages and periventricular leukomalacia (PVL) among surviving children ranging from 38 to 74% [2]. Catamnestic adverse lesions of the nervous system are intraventricular hemorrhage (ivh) grade 3-4 and the cystic form of periventricular leukomalacia (ivh grade 3 frequency of disability is 45%, with DRCS-4 - 86%, with a combination of ivh and PVL - 78%) [3]. The reasons for such a frequent disability with massive ivh include ischemic injury periventricular tissue walls dramatically enlarged ventricle with development of edema of the brain tissue and acute intracranial hypertension; on the other hand, long-term persistence of post-hemorrhagic ventriculomegaly prolong further itemization Mozgova� parenchyma [4]. However, even a mild degree of brain damage in premature infants may lead to various abnormalities in the development of the Central nervous system.

The level of technology

The analogue of this invention is a method of diagnosing occlusal postemergency of hydrocephalus according to the results of neurosonography (NSG) and computed tomography (CT) of the brain [Hydrocephalus, Eugenia-Daniela Hord, MD. WebMD Health, Emedicine journal. April 10, 2006], namely to determine the size of the ventricles of the brain, the patency of cerebrospinal fluid pathways.

The disadvantage of this method is that it is impossible to conduct daily NSG and/or CT of the brain due to the high cost of equipment and research, thus increasing the likelihood of late diagnosis and late surgery with subsequent adverse neurological outcomes associated with atrophy of the cerebral cortex of the brain.

The prototype of the present invention is "a Method of diagnosing occlusal postemergency hydrocephalus in premature infants with peri-intraventricular hemorrhage" (patent No. 2327163), which consists in determining the child at 7-14 day life amount of protein in the cerebrospinal fluid, and its quantity equal to or greater than 3.5 g/l, diagnose occlusal postemergency hydrocephalus [5]. The method allows to 14 days of life diagnostician�to the child occlusal postemergency hydrocephalus.

Despite the obvious advantages of the method (the diagnostic threshold), there are some disadvantages:

- increase amounts of protein in the cerebrospinal fluid is not a specific indicator to verify occlusal postemergency hydrocephalus and can be observed in other pathologies [6];

- the use of one parameter and the absence of mathematical modeling reduces the effectiveness of this method of prediction.

Summary of the invention

The aim of the invention is to provide a method of predicting the formation of occlusive posthemorrhagic hydrocephalus in preterm infants with ELBW and presence of intraventricular hemorrhage III degree on the basis of laboratory studies serum of umbilical cord and peripheral blood, which consists in determining the concentration of neuron-specific enolase (NSE) and brain-derived neurotrophic factor (BDNF) in umbilical cord blood, as well as the concentration of vascular endothelial factor (VEGF) in the umbilical cord and peripheral blood (on day 7 of life).

The method is performed as follows: blood sampling produce a premature baby at birth from the umbilical vein in an amount of 1.0 ml and on the 7th day of life from any available peripheral vein in an amount of 500 μl and then in serum is carried out Oprah�for the same concentration of BDNF, VEGF and NSE by enzyme immunoassay according to the instructions of the manufacturer. Measurement of the optical density of the samples is done on the analyzer "VICTOR 2" company "PerkinElmer" ("Wallac Oy, Finland).

On the basis of mathematical processing of results of research by the method of discriminant analysis informative signs and formed a method of predicting the formation of occlusive posthemorrhagic hydrocephalus in preterm infants with ELBW and presence of intraventricular hemorrhage, grade III which is to determine prognostic index (PI) according to the formula:

PI=-0,007 X X1+0,006×X2To -0.05×X3+0,0004×X4-3,9, where

X1the VEGF concentration in umbilical cord blood at birth (ng/ml);

X2- the concentration of VEGF in the peripheral blood on day 7 of life (ng/ml);

X3- NSE concentration in cord blood (µg/l);

X4the BDNF concentration in cord blood (ng/ml);

Const=-3,9.

When PI is more than 0 make a conclusion about the absence of risk of formation of occlusive posthemorrhagic hydrocephalus, and when PI is less than 0 predict a high risk of developing this disease.

The specificity of the proposed method is to 72.7%, sensitivity of 75%. Process efficiency is 73%.

To verify the diagnosis of ivh was used neurosonography (NSG), which�th reflects the morphological substrate and can be used only for diagnosis, and not predict.

Example 1. Newborn Mr. (case No. 51054), was born from the second pregnancy, the second birth. The pregnancy was complicated by severe preeclampsia, chronic fetoplacental insufficiency. The child was born at the gestational age of 27 weeks in a very serious condition, weight 560 g, length 32 cm, with rating on a scale of Apgar 1/5 points.

According to laboratory research, the VEGF concentration in cord blood was 1,085 ng/ml in peripheral blood on day 7 - 1989 ng/ml. the Concentration of NSE and BDNF in umbilical cord blood was 61,1 µg/l and 4930 ng/ml, respectively.

According to the formula determined the prognostic value of the index:

PI=-0,007×1085+0,006×1989-0,05×61,1+0,0004×4930-3,9=-0,64,

that is less than 0 and indicates a high risk of formation of occlusive posthemorrhagic hydrocephalus.

The child's condition at birth was estimated as very heavy due to the flow of respiratory distress syndrome and intrauterine infection on the background of deep immaturity, in connection with which a newborn was on the high-frequency artificial lung ventilation (ALV) for 10 days. Total duration of mechanical ventilation was 42 days. Neurosonography on the 1st day of life diagnosed with a grade III level. The results of the people's Assembly on the 30th day of life: posthemorrhagic occlusive hydrocephalus. The forecast for claimed with�person confirmed.

Example 2. Newborn U-on (case No. 20243), was born from the third pregnancy, premature birth, the second child of biharilal biamniotic twins. Pregnancy proceeded against the background of chronic placental insufficiency subcompensated form of severe pre-eclampsia (12 points), impairment of uteroplacental blood flow II. The child was born at the gestational age of 25 weeks in a very serious condition, weight 750 g, length 32 cm, with rating on a scale of Hangar in the first minute - 2 points, 5 minute - 4 points.

The VEGF concentration in cord blood was 225,8 ng/ml in peripheral blood on day 7 - 662,4 ng/ml. the Concentration of NSE and BDNF in cord blood amounted to 1.56 μg/l and 5530 ng/ml, respectively.

According to the formula determined the prognostic value of the index:

PI=-0,007×225,8+0,006×662,4-0,05×1,56+0,0004×5530-3,9-0,63, what is greater than 0 and indicates the absence of risk of formation of occlusive posthemorrhagic hydrocephalus.

The child's condition at birth was very difficult due to the respiratory, neurological disturbances on the background of deep immaturity. Were on a high-frequency artificial ventilation for 3 days, followed by transfer to a traditional ventilator. With the first day according to the people's Assembly revealed a grade II degree with progression to grade III grade to 3 days of life. By the age of 1 month�CA life data for occlusive hydrocephalus neurosonography is not received. Forecast according to the claimed method was confirmed.

Thus, the claimed method for predicting the formation of occlusive posthemorrhagic hydrocephalus in premature infants has the following advantages:

1. The method allows the end of the early neonatal period to diagnose the formation of occlusive posthemorrhagic hydrocephalus as an outcome of severe intraventricular hemorrhage III level in a newborn infant with extremely low body weight at birth.

2. Does not require special training of the child to the study.

3. The proposed method allows to allocate newborns in high-risk groups, promptly appoint adequate therapy and to adjust tactics and observation.

Sources of information

1.Barashnev Y. I. Clinical and morphological characteristics and outcomes of cerebral disorders in hypoxic-ischemic encephalopathy. Akush. and gin., 2000; 5: 39-42.

2. Kaija Mikkola et al. Neurodevelopmental Outcome at 5 Years of Age of a National Cohort of Extremely Low Birth Weight Infants Who Were Born in 1996-1997 Pediatrics. December 2005. - V. - 116. - P. 1391-1400.

3. Simonovic V. Periventricular hemorrhage and ischemia in premature infants. From the book "Prematurity". Moscow: Medicine, 1991.

4. Fedorov L. A. Neurological outcomes of critical States early neonatal period in preterm infants with very low and extremely n�scoi body weight at birth]... Diss. Cand. honey. Sciences. - SPb. - 2003. - 21 p.

5. Ironskin E. V., Shershnev V. N. "A method for diagnosing occlusal postemergency hydrocephalus in premature infants with peri-intraventricular hemorrhage". Patent No. 2327163 from 20.06.2008.

6. Mardanly S. G., Pervushin Yu., Ivanov V. N. Cerebrospinal fluid, laboratory methods and their clinical and diagnostic value: a training manual for professionals in clinical laboratory diagnostics. Elektrogorsk: ZAO Ecolab, 2011. - 72 S.

A method of predicting the formation of occlusive posthemorrhagic hydrocephalus in premature infants with extremely low body weight at birth, characterized in that the premature baby based immunoassay studies of umbilical cord serum and peripheral blood to determine the concentration of neuron-specific enolase (NSE), the concentration of brain-derived neurotrophic factor (BDNF), concentration of vascular endothelial factor (VEGF) in cord blood and the concentration of vascular endothelial factor (VEGF) in peripheral blood at 7 days of life, calculated prognostic index (PI) according to the formula:
PI=-0,007 X X1+0,006×X2To -0.05×X3+0,0004×X4-3,9, where
X1the VEGF level in cord blood at birth (ng/ml);
X2- the content of VEGF in the peripheral blood on day 7 of life (ng/ml);
X3- the content of NSE in umbilical cord blood (µg/l);
X4- the content of BDNF in cord blood (ng/ml);
Const=-3,9;
and when the PI is more than 0 make a conclusion about the absence of risk of formation of occlusive posthemorrhagic hydrocephalus, and when PI is less than 0 predict a high risk of developing this disease.



 

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