Germinal matrix-intraventricular hemorrhage (GMH-IVH) represents the primary cause of neurological sequelae in preterm infants. Early prediction and integrated management of GMH-IVH are crucial for enhancing prognosis. Cerebral blood flow (CBF) disturbances induced by blood pressure fluctuations, along with the heightened bleeding risk attributed to immature coagulation function, constitute key pathogenic factors contributing to GMH-IVH.

To evaluate the predictive significance of coagulation function in conjunction with BPV for germinal matrix-intraventricular hemorrhage (GMH-IVH) in preterms with a gestational age of 32 weeks or less.

A total of 106 preterm infants with a gestational age of≤32 weeks who were admitted to the neonatal intensive care unit (NICU) of Affiliated Hospital of Yangzhou University and met the inclusion criteria between June 2022 and June 2024 were enrolled as research subjects. Based on the presence or absence of GMH-IVH, the preterm infants were categorized into the GMH-IVH group (n=51) and the non-GMH-IVH group (n=55). According to their short-term outcomes, they were further divided into the good outcome group (n=30) and the poor outcome group (n=21). Comprehensive data collection included general information and perinatal parameters of the enrolled preterm infants. Coagulation function, systolic blood pressure (SBP), diastolic blood pressure (DBP), and blood pressure variability (BPV) indices were monitored for each group, and the associations between these indices and GMH-IVH were analyzed. Binary Logistic regression analysis was conducted to identify risk factors for GMH-IVH and poor outcomes in preterm infants. Additionally, ROC curves were constructed to evaluate the predictive performance of identified risk factors for GMH-IVH and poor outcomes, with the area under the curve (AUC) calculated accordingly.

A total of 106 preterm infants were enrolled in the study, comprising 43 males (40.6%) and 63 females (59.4%). Binary Logistic regression analysis revealed that the international normalized ratio (INR) (OR=5.608, 95%CI=2.858-8.587, P=0.003) and standard deviation (SD) of DBP (OR=1.455, 95%CI=1.003-2.111, P=0.038) were significant independent risk factors for GMH-IVH in preterm infants. The AUC for the combined prediction of GMH-IVH using INR SD and DBP SD was 0.803, with a sensitivity of 82.4% and specificity of 79.7%. Furthermore, binary Logistic regression analysis indicated that INR SD (OR=3.942, 95%CI=1.509-6.680, P=0.025) and DBP SD (OR=2.334, 95%CI=1.013-5.378, P=0.047) were associated with poor outcomes of GMH-IVH. The AUC for predicting poor outcomes using INR SD and DBP SD was 0.864, with a sensitivity of 76.2% and specificity of 90.0%.

Increased INR and DBP SD are independent risk factors for occurrence and poor short-term prognosis of GMH-IVH. Combined monitoring of INR and DBP SD has certain reference value for early identification and prognosis evaluation of GMH-IVH.

生发基质-脑室内出血（GMH-IVH）是早产儿并发神经系统后遗症的主要原因。早期预测GMH-IVH并进行综合管理，对改善早产儿预后尤为重要。血压波动导致的脑血流（CBF）紊乱以及凝血功能不成熟引起的出血风险增加是GMH-IVH的重要致病因素。

分析血压变异性（BPV）和凝血功能联合检测对胎龄≤32周早产儿GMH-IVH的早期预测价值，并评估其近期预后。

选取2022年6月—2024年6月在扬州大学附属医院新生儿重症监护病房住院并符合标准的胎龄≤32周早产儿106例作为研究对象。按照是否存在GMH-IVH将早产儿分为GMH-IVH组（51例）和非GMH-IVH组（55例）；按照短期转归将早产儿分为转归良好组（30例）和转归不良组（21例）。收集入组早产儿的一般资料以及围生期资料，监测各组患儿凝血功能和收缩压（SBP）、舒张压（DBP）的BPV指标，分析各指标与GMH-IVH的关系。采用二元Logistic回归分析探讨早产儿GMH-IVH及转归不良的危险因素，绘制危险因素预测早产儿GMH-IVH及转归不良的ROC曲线，并计算ROC曲线下面积（AUC）。

共纳入106例早产儿，其中男43例（40.6%）、女63例（59.4%）。二元Logistic回归分析结果显示，国际标准化比值（INR）（OR=5.608，95%CI=2.858~8.587，P=0.003）、DBP的标准差（SD）（OR=1.455，95%CI=1.003~2.111，P=0.038）升高是早产儿发生GMH-IVH的独立危险因素；INR、DBP的SD联合预测早产儿发生GMH-IVH的AUC为0.803，其灵敏度为82.4%，特异度为79.7%。二元Logistic回归分析结果显示，INR（OR=3.942，95%CI=1.509~6.680，P=0.025）、DBP的SD（OR=2.334，95%CI=1.013~5.378，P=0.047）升高是早产儿GMH-IVH转归不良的危险因素；INR、DBP的SD联合预测早产儿GMH-IVH转归不良的AUC为0.864，灵敏度为76.2%，特异度为90.0%。

INR、DBP的SD升高是早产儿发生GMH-IVH及其短期预后不良的危险因素，联合INR、DBP的SD监测对于早产儿GMH-IVH的早期识别和预后预测存在一定的临床价值。