RU2167608C1 - Method for predicting hypoxic ischemic encephalopathy in mature newborns - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves performing clinical examination of pregnant woman, ultrasonic examination of uterine arteries, umbilical arteries and median cerebral artery of the fetus, detecting risk factors, analyzing them and the ultrasonic examination data to determine their discrete levels and numeric values. Prognosis coefficients F1 and F2 are calculated using formulas. F1 being found to be greater than or equal to F2, hypoxic ischemic encephalopathy occurrence is to be predicted in mature newborn to be born in term by the woman under investigation. EFFECT: enhanced accuracy of prognosis. 1 tbl

Description

 The invention relates to medicine, namely to neurology and obstetrics and gynecology, and can be used to predict the development of hypoxic-ischemic encephalopathy in full-term newborns.

 The problem of perinatal lesions of the nervous system in newborns remains relevant because of the high frequency and great importance for the further life of a person (Barashnev Yu.I., Bessonova Yu.V. // Akush. And gin.-1997. - N 2. - C. 28-33). Ante- and intranatal hypoxia is the leading cause of perinatal damage to the nervous system in newborns, including hypoxic-ischemic encephalopathy (Guide to Pediatric Neurology / Edited by V.I. Guzeva. - St. Petersburg, 1998. - 493 p.). However, predicting the consequences of intrauterine hypoxia presents significant difficulties due to the large number of factors that determine the degree of damage to the fetal nervous system. In addition, neurological well-being in the neonatal period in newborns at risk does not guarantee a favorable outcome in the future (Savelyeva G.M., Sichinava L.G. // Russian Bulletin of Perinatology and Pediatrics. - 1995. - N 3. - P. 19 -23). Therefore, the focus of attention of obstetricians, neonatologists and neurologists remains such issues as determining the role of adverse factors in the pathogenesis of perinatal lesions of the central nervous system, assessing the degree of risk for a pregnant woman and fetus, and searching for reliable criteria for the immediate and long-term prognosis of child development. The selection of reliable markers for the development of perinatal hypoxic-ischemic encephalopathy in full-term newborns will allow timely identification of pregnant women at increased risk for individual therapeutic and preventive measures.

 All of the above indicates the need for antenatal prediction of the development of hypoxic-ischemic encephalopathy in full-term newborns.

Currently, in the process of working with a pregnant obstetrician or neonatologist, when collecting an anamnesis, clinical and paraclinical examination, he may suggest the development of hypoxic-ischemic encephalopathy in a newborn, but this assumption is largely approximate and subjective (Bodyagina V.I., Zhmakin K .N., Kiryushchenkov A.P. Obstetrics. - Kursk, 1995. - 496 p.)
The aim of the invention is to improve the accuracy of predicting the development of hypoxic-ischemic encephalopathy in full-term newborns.

This goal is achieved by conducting a clinical examination of the pregnant woman, an ultrasound examination of the uterine arteries, umbilical arteries and the middle cerebral artery of the fetus, identifying risk factors, analyzing and analyzing ultrasound parameters, determining their gradations and numerical values, and calculating prognostic factors F ₁ and F ₂ according to the proposed formulas. With the value of prognostic factors F ₁ ≥ F _{2, the} development of hypoxic-ischemic encephalopathy in a full-term newborn who is born in the examined woman is predicted.

Comparative analysis with the prototype showed that the proposed method differs from the known one in that it additionally conducts an ultrasound examination of the uterine arteries, umbilical arteries and the middle cerebral artery of the fetus, identifies risk factors, analyzes ultrasound parameters and risk factors, determines their gradations and numerical values and calculate prognostic factors F ₁ and F ₂ according to the formulas:
F ₁ = -33.42 + 2.12 • a ₁ + 2.19 • a ₂ + 7.17 • a ₃ + 7.61 • a ₄ + 8.72 • a ₅ - 3.85 • a ₆ + 1.79 • a ₇ - 6.92 • a ₈ + 10.04 • a ₉ - 0.06 • a ₁₀ + 0.49 • a ₁₁ + 3.74 • a ₁₂ + 3.56 • a ₁₃ - 11 , 8 • a ₁₄ ;
F ₂ = -24.48 + 1.95 • a ₁ + 0.62 • a ₂ + 5.09 • a ₃ + 6.01 • a ₄ + 7.46 • a ₅ - 3.99 • a ₆ - 0.23 • a ₇ - 7.48 • a ₈ + 6.7 • a ₉ + 0.71 • a ₁₀ + 0.13 • a ₁₁ + 4.25 • a ₁₂ + 1.81 • a ₁₃ - 11 , 16 • a ₁₄ ,
where a _{1,2 ... 14} - gradations and numerical values of risk factors, ultrasound parameters (a ₁ - age, a ₂ - chronic psycho-emotional stress, a ₃ - hypertension or autonomic-vascular dystonia, and ₄ - menstrual dysfunction , a ₅ - smoking during pregnancy, a ₆ - the number of abortions of more than 3, a ₇ - the threat of interruption in the second half of pregnancy, a ₈ - chronic fetoplacental insufficiency, a ₉ - chronic intrauterine hypoxia of the fetus, a ₁₀ - intrauterine growth retardation syndrome fetal development, a ₁₁ - OPT- estoz duration of 4 weeks or more, a ₁₂ - systolic-diastolic ratio umbilical artery, a ₁₃ - systolic-diastolic ratio uterine arteries, a ₁₄ - systolic-diastolic ratio middle cerebral fetal artery), and a value of prediction coefficients F ₁ ≥ F ₂ predict the development of hypoxic-ischemic encephalopathy in a full-term newborn who will be born in the examined woman.

 Thus, the proposed technical solution meets the criteria of the invention of "novelty."

 The analysis of patent and specialized literature showed that the proposed technical solution differs from other technical solutions in this and related fields. So, we did not meet the risk factors we proposed and their combination in pregnant women, as well as the analysis of ultrasound parameters of the uterine arteries, umbilical artery and the middle cerebral artery of the fetus in order to predict the development of hypoxic-ischemic encephalopathy in full-term newborns, namely, this set of risk factors with taking into account the parameters of ultrasound examination of women in the third trimester of pregnancy, they allow with a high degree of accuracy (88.9%) to predict the birth of newborns with hypoxia in them cally-ischemic encephalopathy.

 Thus, the proposed method meets the criteria of the invention of "inventive step".

 Our forecasting method can be used in the work of an obstetrician-gynecologist, neonatologist, pediatric neurologist and pediatrician at the inpatient and outpatient levels. Based on the foregoing, the method meets the criteria of the invention of "industrial applicability".

 The method is as follows.

A woman in the third trimester of pregnancy undergoes a clinical examination, an ultrasound examination of blood flow in the umbilical arteries, uterine arteries, and the middle cerebral artery of the fetus, identify risk factors and analyze the latter, as well as analyze ultrasound parameters and determine their gradations and numerical values:
1. Age: in years.

 2. Chronic psycho-emotional stress: 0 - no; 1 - is.

 3. Hypertension or vegetative-vascular dystonia: 0 - no; 1 - is.

 4. Menstrual dysfunction: 0 - no; 1 - is.

 5. Smoking during pregnancy: 0 - no; 1 - is.

 6. The number of abortions more than 3: 0 - no; 1 - is.

 7. The threat of interruption in the second half of pregnancy: 0 - no; 1 - is.

 8. Chronic fetoplacental insufficiency: 0 - no; 1 - is.

 9. Chronic intrauterine hypoxia of the fetus: 0 - no; 1 - is.

 10. Syndrome of intrauterine growth retardation: 0 - no; 1 - is.

 11. OPT-gestosis lasting 4 weeks or more: 0 - no; 1 - is.

 12. Systolic-diastolic ratio of the umbilical artery: 0 - 2.7 or less; 1 - more than 2.7.

 13. Systolic-diastolic ratio of uterine arteries: 0 - 2.5 or less; 1 - more than 2.5.

 14. Systolic-diastolic ratio of the middle cerebral artery of the fetus: 0 - 4.0 or more; 1 - less than 4.0.

Then calculate the prognostic factors according to the formulas
F ₁ = -33.42 + 2.12 • a ₁ + 2.19 • a ₂ + 7.17 • a ₃ + 7.61 • a ₄ + 8.72 • a ₅ - 3.85 • a ₆ + 1.79 • a ₇ - 6.92 • a ₈ + 10.04 • a ₉ - 0.06 • a ₁₀ + 0.49 • a ₁₁ + 3.74 • a ₁₂ + 3.56 • a ₁₃ - 11 , 8 • a ₁₄ ;
F ₂ = -24.48 + 1.95 • a ₁ + 0.62 • a ₂ + 5.09 • a ₃ + 6.01 • a ₄ + 7.46 • a ₅ - 3.99 • a ₆ - 0.23 • a ₇ - 7.48 • a ₈ + 6.7 • a ₉ + 0.71 • a ₁₀ + 0.13 • a ₁₁ + 4.25 • a ₁₂ + 1.81 • a ₁₃ - 11 , 16 • a ₁₄ ,
where a _{1,2 ... 14} are gradations and numerical values of risk factors, ultrasound parameters (a ₁ is age, a ₂ is chronic psychoemotional stress, a ₃ is hypertension or vegetative-vascular dystonia, a ₄ is menstrual dysfunction, a ₅ - smoking during pregnancy, a ₆ - the number of abortions of more than 3, a ₇ - the threat of abortion in the second half of pregnancy, a ₈ - chronic fetoplacental insufficiency, a ₉ - chronic intrauterine hypoxia of the fetus, a ₁₀ - syndrome of intrauterine growth retardation , a ₁₁ - OPT-g aestosis lasting 4 weeks or more, a ₁₂ is the systole-diastolic ratio of the umbilical artery, ₁₃ is the systole-diastolic ratio of the uterine arteries, and ₁₄ is the systole-diastolic ratio of the middle cerebral artery of the fetus).

With the value of prognostic factors F ₁ ≥ F _{2, the} development of hypoxic-ischemic encephalopathy in a full-term newborn who is born in the examined woman is predicted.

 Example 1. Pregnant Naletova N.V. Diagnosis: Pregnancy 32 weeks. Syndrome of intrauterine growth retardation of the fetus of 1 degree. Chronic fetoplacental insufficiency. Chronic intrauterine hypoxia of the fetus. Diffuse enlargement of the thyroid gland 2 degrees. Nicotine intoxication. Myopia 2 degrees.

Risk factors are identified, ultrasound indicators are obtained, their gradations and numerical values are determined:
1. Age: - 19 years old, a ₁ = 19.

2. Chronic psycho-emotional stress: - is, a ₂ = 1.

3. Hypertension or vegetative-vascular dystonia: - yes, a ₃ = 1.

4. Menstrual dysfunction: - no, a ₄ = 0.

5. Smoking during pregnancy: - is, a ₅ = 1.

6. The number of abortions is more than 3: - no, a ₆ = 0.

7. The threat of interruption in the second half of pregnancy: - is, and ₇ = 1.

8. Chronic fetoplacental insufficiency: - yes, a ₈ = 1.

9. Chronic intrauterine hypoxia of the fetus: - yes, a ₉ = 1.

10. Syndrome of intrauterine growth retardation: - yes, a ₁₀ = 1.

11. OPT gestosis lasting 4 weeks or more: - yes, a ₁₁ = 1.

12. Systolic-diastolic ratio of the umbilical artery: - 3.2, a ₁₂ = 1.

13. Systolic-diastolic ratio of uterine arteries: 3.0, a ₁₃ = 1.

14. Systolic-diastolic ratio of the middle cerebral artery of the fetus: - 3.5, a ₁₄ = 1.

The prognostic factors F ₁ and F _{2 are} calculated by the formulas
F ₁ = -33.42 + 2.12 • 19 + 2.19 • 1 + 7.17 • 1 + 7.61 • 0 + 8.72 • 1 - 3.85 • 0 + 1.79 • 1 - 6.92 • 1 + 10.04 • 1 - 0.06 • 1 + 0.49 • 1 + 3.74 • 1 + 3.56 • 1 - 11.8 • 1 = 25.78;
F ₂ = -24.48 + 1.95 • 19 + 0.62 • 1 + 5.09 • 1 + 6.01 • 0 + 7.46 • 1 - 3.99 • 0 - 0.23 • 1 - 7.48 • 1 + 6.7 • 1 + 0.71 • 1 + 0.13 • 1 + 4.25 • 1 + 1.81 • 1 - 11.16 • 1 = 19.52;
F ₁ > F ₂ .

 Conclusion: the newborn is at risk of developing hypoxic-ischemic encephalopathy.

 Note: a woman had a full-term boy with hypoxic-ischemic encephalopathy, manifested by syndromes of increased neuro-reflex excitability and motor disorders.

 Example 2. Pregnant Naumova VP Diagnosis: Pregnancy 30 weeks. Violation of the uteroplacental blood flow 1A. Chronic pyelonephritis without exacerbation.

Risk factors are identified, ultrasound indicators are obtained, their gradations and numerical values are determined:
1. Age: - 28 years old, a ₁ = 28.

2. Chronic psycho-emotional stress: - no, a ₂ = 0.

3. Hypertension or vegetative-vascular dystonia: - no, a ₃ = 0.

4. Menstrual dysfunction: - no, a ₄ = 0.

5. Smoking during pregnancy: - no, a ₅ = 0.

6. The number of abortions is more than 3: - no, but ₆ = 0.

7. The threat of interruption in the second half of pregnancy: - no, but ₇ = 0.

8. Chronic fetoplacental insufficiency: - yes, a ₈ = 1.

9. Chronic intrauterine hypoxia of the fetus: - no, a ₉ = 0.

10. Syndrome of intrauterine growth retardation: - no, a ₁₀ = 0.

11. OPT gestosis lasting 4 weeks or more: - no, a ₁₁ = 0.

12. Systolic-diastolic ratio of the umbilical artery: - 2.4, a ₁₂ = 0.

13. Systolic-diastolic ratio of uterine arteries: 3.1, a ₁₃ = 1.

14. Systolic-diastolic ratio of the middle cerebral artery of the fetus: - 4.3, a ₁₄ = 0.

The prognostic factors F ₁ and F _{2 are} calculated by the formulas
F ₁ = -33.42 + 2.12 • 28 + 2.19 • 0 + 7.17 • 0 + 7.61 • 0 + 8.72 • 0 - 3.85 • 0 + 1.79 • 0 - 6.92 • 1 + 10.04 • 0 - 0.06 • 0 + 0.49 • 0 + 3.74 • 0 + 3.56 • 1 - 11.8 • 0 = 22.56;
F ₂ 2 = -24.48 + 1.95 • 28 + 0.62 • 0 + 5.09 • 0 + 6.01 • 0 + 7.46 • 0 - 3.99 • 0 - 0.23 • 0 - 7.48 • 1 + 6.7 • 0 + 0.71 • 0 + 0.13 • 0 + 4.25 • 0 + 1.81 • 1 - 11.16 • 0 = 24.45;
F ₂ > F ₁ .

 Conclusion: the development of hypoxic-ischemic encephalopathy is not threatened.

 Note: the woman had a full-term healthy boy.

 Evaluation of the effectiveness of the proposed forecasting method was carried out in the training and control samples. In the training sample, the correct recognition was 87.2% for full-term infants with hypoxic-ischemic encephalopathy and 92.7% for full-term infants without hypoxic-ischemic encephalopathy. In the control group consisting of 36 full-term infants with hypoxic-ischemic encephalopathy, the diagnosis of the latter was correctly predicted in 32 of them. The accuracy of predicting the development of hypoxic-ischemic encephalopathy in full-term newborns was 88.9%.

 As a result of enumerating many possible options for combinations of risk factors in a pregnant woman, ultrasound examination of the uterine arteries, umbilical artery and middle cerebral artery of the fetus, an optimal combination of 14 of them was obtained, with which the forecast accuracy was maximum. Therefore, to predict the development of hypoxic-ischemic encephalopathy in full-term newborns, we used 14 risk factors and ultrasound parameters of the pregnant woman and the fetus that we described. When evaluating the effectiveness of the method, it was precisely with their number and combination in the training set that the correct recognition was optimal (see table).

 The proposed method makes it possible with a high degree of accuracy (88.9%) to identify pregnant women whose full-term newborns are threatened with the development of hypoxic-ischemic encephalopathy, i.e., to predict its occurrence in the fetus. This allows you to carry out "threatened" by the birth of a child with hypoxic-ischemic encephalopathy to pregnant women individual therapeutic and preventive measures that prevent the development of this disease in a newborn.

Claims (1)

A method for predicting the development of hypoxic-ischemic encephalopathy in full-term newborns, including a clinical examination of a pregnant woman, characterized in that they additionally conduct ultrasound examination of the uterine arteries, umbilical arteries and middle cerebral artery of the fetus, identify risk factors, analyze ultrasound parameters and risk factors, determine them gradations and numerical values and calculate the prognostic factors F ₁ and F ₂ according to the formulas
F ₁ = -33.42 + 2.12 • a ₁ + 2.19 • a ₂ + 7.17 • a ₃ + 7.61 • a ₄ + 8.72 • a ₅ - 3.85 • a ₆ + 1.79 • a ₇ - 6.92 • a ₈ + 10.04 • a ₉ - 0.06 • a ₁₀ + 0.49 • a ₁₁ + 3.74 • a ₁₂ + 3.56 • a ₁₃ - 11 , 8 • a ₁₄ ;
F ₂ = -24.48 + 1.95 • a ₁ + 0.62 • a ₂ + 5.09 • a ₃ + 6.01 • a ₄ + 7.46 • a ₅ - 3.99 • a ₆ - 0.23 • a ₇ - 7.48 • a ₈ + 6.7 • a ₉ - 0.71 • a ₁₀ + 0.13 • a ₁₁ + 4.25 • a ₁₂ + 1.81 • a ₁₃ - 11 , 16 • a ₁₄
where a _{1,2 ... 14} - gradations and numerical values of risk factors (RF), ultrasound indicators:
a ₁ is the age;
a ₂ - chronic psychoemotional stress;
a ₃ - hypertension or vegetative-vascular dystonia;
a ₄ - menstrual dysfunction;
a ₅ - smoking during pregnancy;
a ₆ - the number of abortions of more than three;
a ₇ - threatened abortion in the second half of pregnancy;
a ₈ - chronic fetoplacental insufficiency;
a ₉ - chronic fetal hypoxia of the fetus;
a ₁₀ - intrauterine growth retardation syndrome;
a ₁₁ - OCG-gestosis lasting 4 weeks or more;
a ₁₂ - systolic-diastolic ratio of the umbilical artery;
a ₁₃ - systolic-diastolic ratio of the uterine arteries;
a ₁₄ - systolic-diastolic ratio of the middle cerebral artery of the fetus,
and with the value of prognostic factors F ₁ ≥ F _{2, the} development of hypoxic-ischemic encephalopathy in a full-term newborn who is born in the examined woman is predicted.

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