الفهرس 
INTRAVENTRICULAR HAEMORRHAGE OF PREMATURE INFANTOnly 14 pages are availabe for public view
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Abstract
I
ntraventricular hemorrhage is an important cause of cognitive and motor neurological impairment in preterm infants, and is associated with high morbidity and mortality rates in the neonatal period. Early and accurate evaluation of the severity of this brain insult remains one of the most difficult problems in neonatal care units.
The aim of our study was to determine whether CCL18 expression by cord blood and /or peripheral blood mononuclear cells would help to predict the risk of intraventricular hemorrhage among preterms.
The study was carried out in the neonatal intensive care unit of Maternity Hospital of Ain shams. It included 44 preterm infants with gestational age ranging from 28-32 weeks and birth weight ranging between 750-1900 gm. The neonates included in this study were divided into two groups, group 1 comprised 21 preterms without intraventricular hemorrhage, group 2 comprised 23 preterm infants suffering from intraventricular hemorrhage, with exclusion of congenital malformations.
All studied neonates were subjected to full perinatal history and a thorough clinical examination with assessment of Apgar score at 1 and 5 minutes after birth, birth weight and gestational age.
General and neurological examination were done at inclusion for all preterms, cord blood and blood sample at day 2 were drawn and examined using flowcytometry technique. Cranial ultrasonography also was done for assessment of the presence and grades of intraventricular hemorrhage at day 3 and at day 7.
Our results revealed that cord blood CCL18 expression were predictable in all preterms at median 6.46 (IQR 2.65-14.9) (table 15, figure 35). They were shown not to be influenced by birth weight, APGAR score at 1,5 minutes, gestational age assessed by Ballard, nor hemoglobin level,platelets, TLC, nor granulocytes as shown in table 20.
Peripheral blood CCL18 levels measured on second day predicted in all preterms at median 3.79 (IQR 1.6-7.89)(Table 15, figure 35). They were shown to be influenced by platelets as measured at day 3, but not influenced by birth weight, APGAR 1,5 minutes, gestational age assessed by Ballard, hemoglobin level,TLc, nor granulocytes (Table 21, figure 42).
In our study, there was non statistical significant difference for cord CCL18 in preterms without IVH {median 8.12(2.37-16.4)} compared to preterms with IVH {median 6.125(4.4-14.85)} (table 16, figure 36).
Also there was non statistical significant difference for peripheral blood CCL18 in preterms without IVH {median 3.05(1.6-7.89)} compared to preterms with IVH {median 4.4(1.7-7.04)} (Table 16, figure 35).
The results of the study revealed that the chemokine CCL18 expression in cord blood and blood sample were elevated in preterm infants with intraventricular hemorrhage compared to preterms who hadn’t intraventricular hemorrhage (but it was not significant statisticaly differ).
Cord CCL18 and blood CCL18 were not statistically increased in preterm infants with intraventricular hemorrhage.
In conclusion, the results of the present study demonstrated that expression of CCL18 by neonatal mononuclear blood cells is neither sensitive nor specific biomarker for IV.