Yuan Liping,Wu Shuihua,Hu Jihong,et al.Analysis of factors associated with cerebral palsy after neonatal intracranial hemorrhage[J].Journal of Clinical Pediatric Surgery,2026,(02):130-135.[doi:10.3760/cma.j.cn101785-101785-20251104-00040]
新生儿期脑出血后发生脑性瘫痪的相关因素分析
- Title:
- Analysis of factors associated with cerebral palsy after neonatal intracranial hemorrhage
- Keywords:
- Cerebral Hemorrhage; Infant; Newborn; Cerebral Palsy; Factor Analysis; Statistical
- 摘要:
- 目的 识别新生儿期脑出血后脑性瘫痪(cerebral palsy,CP)发生的相关因素,构建并评估早期判别模型,为临床筛查与干预决策提供依据。方法 采用单中心回顾性队列研究设计,纳入2020年1月至2024年6月在中南大学湘雅医学院附属儿童医院(湖南省儿童医院)康复中心接受规范评估及干预、且资料完整的新生儿期脑出血患儿79例。根据随访结局分为CP组(22例)和非CP组(57例)。收集患儿围产期资料、人口学特征、影像学指标(Papile分级、脑白质软化)及首次康复干预时机等变量。通过单因素分析筛选CP相关候选因素,纳入多因素Logistic回归模型识别独立相关因素;绘制受试者操作特征曲线,比较单指标与多因素联合模型的预测效能,计算曲线下面积(area under the curve,AUC)及最佳阈值。结果 单因素分析显示,CP组与非CP组在入院时年龄、Papile分级、脑白质软化发生率及首次康复干预时间方面差异均有统计学意义(P＜0.05),而胎龄、出生方式、受孕方式、体重、外科干预及癫痫发生情况差异无统计学意义(P＞0.05)。多因素Logistic回归分析证实,脑白质软化(OR=12.639,95%CI:2.273~70.281,P=0.004)与首次康复干预时机延迟(每延迟1天OR=1.072,95%CI:1.009~1.140,P=0.026)是CP发生的独立相关因素。预测效能分析结果显示,单指标AUC依次为:首次康复干预时间0.754、Papile分级0.741、脑白质软化0.734、入院时年龄0.676;多因素联合模型AUC达0.878,显著优于单一指标。基于约登指数确定首次康复干预时间最佳阈值为＞53 d(特异度92.9%,灵敏度59.1%)。结论 新生儿期脑出血后,脑白质软化及康复干预时机延迟与CP发生密切相关;多因素联合预测模型具有更高的判别效能,可有效用于早期风险筛查,为临床制定个体化随访及干预方案提供参考。
- Abstract:
- Objective To identify the factors associated with cerebral palsy (CP) after neonatal intracranial hemorrhage and construct and evaluate an early prediction model. Methods A single-center retrospective study was conducted for 79 neonates with complete records undergoing rehabilitation assessment/intervention between January 2020 and June 2024.Based upon the follow-up outcomes,they were assigned into two groups of CP (n=22) and non-CP (n=57).Perinatal data,imaging indicators (Papile grading,cerebral white matter softening) and "time to initial rehabilitation session (days)" were collected.CP diagnosis served as the outcome for intergroup comparisons and multivariate Logistic regression.ROC (receiver operating characteristic) curves were employed for assessing the discriminatory performance of single and combined models,reporting AUC (area under the curve) and threshold performance. Results There were 52 boys (65.8%) and 27 girls (34.2%).Among 33 preterm (41.8%),22(27.8%) ultimately developed CP.As compared with non-CP group,CP group had a higher age at admission[18.50(10.75,40.50) vs.8.00(3.00,18.00) day,P=0.016],a higher proportion of Papile Ⅲ/Ⅳ grade (72.7% vs.24.6%,P<0.001) and more frequent white matter softening (81.8% vs.35.1%,P<0.001); Initial recovery occurred later[53.50(20.50,60.00) vs.20.00(10.00,32.00) day,P<0.001]; no statistically significant difference existed in epileptic rates between surgical and non-surgical interventions (P>0.05).Multivariate analysis revealed that cerebral white matter softening (OR=12.639,95%CI:2.273-70.281,P=0.004) and delayed initial recovery (OR=1.072 per additional day,95%CI:1.009-1.140,P=0.026) were independent risk factors; Age at admission and Papile grading were not significant after adjustment (P>0.05).Single-factor AUC: admission age 0.676,Papile grade 0.741,cerebral leukomalacia 0.734,delayed initial rehabilitation 0.754; combined model AUC 0.878.Threshold for initial rehabilitation,as determined by the Youden index,was approximately >53 days (specificity 92.9%,sensitivity 59.1%). Conclusions After neonatal intracranial hemorrhage,cerebral leukomalacia and delayed rehabilitation initiation are independently associated with cerebral palsy.The multifactorial combined model demonstrates superior discriminatory performance (AUC:0.878) compared to any single indicator,enabling early risk screening and informing follow-up and intervention decision-making.
参考文献/References:
[1] 中国康复医学会儿童康复专业委员会,中国残疾人康复协会小儿脑性瘫痪康复专业委员会,中国医师协会康复医师分会儿童康复专业委员会,等.中国脑性瘫痪康复指南(2022)第一章:概论[J].中华实用儿科临床杂志,2022,37(12):887-892.DOI:10.3760/cma.j.cn101070-20220505-00500. Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee,Chinese Association of Rehabilitation of Disabled Persons Rehabilitation Committee for Cerebral Palsy,Chinese Medical Doctor Association Pediatric Rehabilitation Committee,et al.Chinese Rehabilitation Guidelines for Cerebral Palsy (2022) Chapter 1: Overview[J].Chin J Appl Clin Pediatr,2022,37(12):887-892.DOI:10.3760/cma.j.cn101070-20220505-00500.
[2] 中国医师协会新生儿科医师分会,北京医师协会新生儿科医师分会,李秋平,等.早产儿脑室内出血预防专家共识(2025)[J].中华妇幼临床医学杂志(电子版),2025,21(1):1-14.DOI:10.3877/cma.j.issn.1673-5250.2025.01.001. Branch of Neonatologists,Chinese Medical Doctor Association; Branch of Neonatologists,Beijing Medical Doctor Association,Li QP,et al.Expert Consensus on Preventing Intraventricular Hemorrhage in Preterm Infants (2025)[J].Chin J Obstet Gynecol Pediatr (Electronic Edition),2025,21(1):1-14.DOI:10.3877/cma.j.issn.1673-5250.2025.01.001.
[3] Wang Y,Song J,Zhang XL,et al.The impact of different degrees of intraventricular hemorrhage on mortality and neurological outcomes in very preterm infants: a prospective cohort study[J].Front Neurol,2022,13: 853417.DOI: 10.3389/fneur.2022.853417.
[4] Rees P,Callan C,Chadda KR,et al.Childhood outcomes after low-grade intraventricular haemorrhage: a systematic review and meta-analysis[J].Dev Med Child Neurol,2024,66(3): 282-289.DOI: 10.1111/dmcn.15713.
[5] 中国康复医学会儿童康复专业委员会,中国残疾人康复协会小儿脑性瘫痪康复专业委员会,中国医师协会康复医师分会儿童康复专业委员会,等.中国脑性瘫痪康复指南(2022)第二章:脑性瘫痪高危儿的评定与干预[J].中华实用儿科临床杂志,2022,37(13):974-982.DOI:10.3760/cma.j.cn101070-20220519-00574. Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee,Chinese Association of Rehabilitation of Disabled Persons Rehabilitation Committee for Cerebral Palsy,Chinese Medical Doctor Association Pediatric Rehabilitation Committee,et al.Chinese Rehabilitation Guidelines for Cerebral Palsy (2022) Chapter II: Assessment and Intervention Guideline for Infants at a High Risk of Cerebral Palsy[J].Chin J Appl Clin Pediatr,2022,37(13): 974-982.DOI:10.3760/cma.j.cn101070-20220519-00574.
[6] Papile LA,Burstein J,Burstein R,et al.Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm[J].J Pediatr,1978,92(4):529-534.DOI:10.1016/s0022-3476(78)80282-0.
[7] Ghotra S,Vincer M,Allen VM,et al.A population-based study of cystic white matter injury on ultrasound in very preterm infants born over two decades in Nova Scotia,Canada[J].J Perinatol,2019,39(2):269-277.DOI:10.1038/s41372-018-0294-5.
[8] Agut T,Alarcon A,Caba?as F,et al.Preterm white matter injury: ultrasound diagnosis and classification[J].Pediatr Res,2020,87(S1):37-49.DOI:10.1038/s41390-020-0781-1.
[9] Zhou XY,Li X,Jin MD,et al.The effects of environmental enrichment in infants with or at high risk of cerebral palsy: an updated systematic review and meta-analysis[J].BMC Pediatr,2025,25(1):642.DOI:10.1186/s12887-025-05954-5.
[10] 唐久来,王宝田,李晓捷.脑性瘫痪早期诊断和脑性瘫痪高风险儿诊断及早期干预进展[J].中华实用儿科临床杂志,2018,33(15):1121-1125.DOI:10.3760/cma.j.issn.2095-428X.2018.15.001. Tang JL,Wang BT,Li XJ.Early accurate diagnosis and early intervention in children with cerebral palsy and high risk of cerebral palsy[J].Chin J Appl Clin Pediatr,2018,33(15):1121-1125.DOI:10.3760/cma.j.issn.2095-428X.2018.15.001.
[11] 刘维民,鲍秀兰,马磊,等.早期干预降低极低出生体重儿脑瘫发生率的临床研究[J].中国儿童保健杂志,2015,23(4):360-363.DOI:10.11852/zgetbjzz2015-23-04-08. Liu WM,Bao XL,Ma L,et al.Clinical study on early intervention to reduce cerebral palsy incidence in very low birth weight children[J].Chin J Child Health Care,2015,23(4):360-363.DOI:10.11852/zgetbjzz2015-23-04-08.
[12] Zhang CX,Zhu ZT,Wang KY,et al.Predicting neurodevelopmental outcomes in extremely preterm neonates with low-grade germinal matrix-intraventricular hemorrhage using synthetic MRI[J].Front Neurosci,2024,18:1386340.DOI:10.3389/fnins.2024.1386340.
[13] Kusters CDJ,Chen ML,Follett PL,et al."Intraventricular" hemorrhage and cystic periventricular leukomalacia in preterm infants: how are they related?[J].J Child Neurol,2009,24(9):1158-1170.DOI:10.1177/0883073809338064.
[14] Leijser LM,Miller SP,van Wezel-Meijler G,et al.Posthemorrhagic ventricular dilatation in preterm infants: When best to intervene?[J].Neurology,2018,90(8): e698-e706.DOI:10.1212/WNL.0000000000004984.
[15] Novak I,Morgan C,Adde L,et al.Early,accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment[J].JAMA Pediatr,2017,171(9):897-907.DOI:10.1001/jamapediatrics.2017.1689.
[16] Kapil N,Majmudar-Sheth B,Johnson T.Hammersmith infant neurological examination subscores are predictive of cerebral palsy[J].Pediatr Neurol,2024,151:84-89.DOI:10.1016/j.pediatrneurol.2023.11.016.
[17] Damiano DL,Longo E.Early intervention evidence for infants with or at risk for cerebral palsy: an overview of systematic reviews[J].Dev Med Child Neurol,2021,63(7):771-784.DOI:10.1111/dmcn.14855.
[18] Boyd SM,Perez D,Juarez M,et al.High-risk infant follow-up: where are we and where to from here?[J/OL].Pediatr Res,2025.https://doi.org/10.1038/s41390-025-04334-0.DOI:10.1038/s41390-025-04334-0.
相似文献/References:
[1]宁岩松,张供.婴儿主动脉弓阻塞病变的外科治疗[J].临床小儿外科杂志,2010,9(06):407.
NING Yan song,ZHANG Gong,Surgical management of aortic arch obstruction associated with cardiac anomalies in infants.[J].Journal of Clinical Pediatric Surgery,2010,9(02):407.
[2]杜朝峻,丁力,胡英超,等.手术治疗婴幼儿法洛四联症83例[J].临床小儿外科杂志,2010,9(06):413.
DU Chao jun,DING Li,HU Ying chao,et al.Surgical treatment of Tetralogy of Fallot in infancy: Experiences of 83 cases.[J].Journal of Clinical Pediatric Surgery,2010,9(02):413.
[3]贾杰,胡祖荣,邓恋,等.瑞芬太尼复合七氟醚在新生儿全身麻醉中的应用[J].临床小儿外科杂志,2010,9(06):464.
[4]郑珊Basnet Anupama黄焱磊陈莲肖现民.新生儿全结肠巨结肠阑尾壁内神经元标记物和神经支配分布的评价[J].临床小儿外科杂志,2011,10(01):0.
ZHENG Shan,Basnet Anupama,HUANG Yan lei,et al.Evaluation of neuronal markers and innervations distribution in TCA appendix.[J].Journal of Clinical Pediatric Surgery,2011,10(02):0.
[5]江峰赵阳孙莲萍金惠明马杰.婴幼儿阻塞性脑积水两种手术方式的疗效比较[J].临床小儿外科杂志,2011,10(01):0.
JIANG Feng,ZHAO Yang,SUN Liang ping,et al.Endoscopic third ventricul ostomy versus ventricul operitoneal shunt:clinical study of obstructive hydro cephalus in infants.[J].Journal of Clinical Pediatric Surgery,2011,10(02):0.
[6]马黎明褚衍林乔衍礼武广华李平萍张来住刘宏生程前进李祥张洪宇陈国庆郑善光刘高利安国营孙卓祥董海新.IL-6、TNF-α及sICAM-1在婴幼儿体外循环肺损伤中的表达及超滤干预效果[J].临床小儿外科杂志,2011,10(01):0.
[7]尹鉴淳
徐万华
李守林
王 浩
刘晓东.新生儿先天性重度肾积水诊疗分析[J].临床小儿外科杂志,2010,9(02):0.
[8]陈 快
戴康临
罗 鸣
邓庆强
陶 强
黄金狮.新生儿胃肠穿孔78例诊治分析[J].临床小儿外科杂志,2010,9(02):0.
[9]王鹏高翟波罗淑颖.婴幼儿室间隔缺损合并肺动脉高压的外科治疗[J].临床小儿外科杂志,2010,9(03):0.
[10]陈快戴康临罗鸣邓庆强陶强黄金狮.新生儿胃肠穿孔78例诊治分析[J].临床小儿外科杂志,2010,9(03):0.
备注/Memo
收稿日期:2025-11-4。
基金项目:2023年湖南省残疾人联合会科研项目(2023YK0313)
通讯作者:吴水华,Email:292454021@qq.com