To investigate the application value of serum interleukin-23(IL-23),tumor necrosis factor-α(TNF-α) and microRNA-146b-5p(miR-146b-5p) in nursing evaluation of full-term neonates with hypoxic-ischemic encephalopathy(HIE),and to analyze their guiding significance for prognostic nursing management.

A total of 95 full-term neonates diagnosed with HIE admitted to our hospital from January 2020 to December 2024 were enrolled as the HIE group.According to the Diagnostic Criteria and Clinical Grading for Neonatal Hypoxic-Ischemic Encephalopathy,they were subdivided into mild subgroup(29 cases),moderate subgroup(44 cases) and severe subgroup(22 cases).Meanwhile,95 healthy full-term neonates were recruited as the control group.Venous blood samples of all subjects were collected within 1 day after admission to detect serum levels of IL-23 and TNF-α.Quantitative real-time polymerase chain reaction(qRT-PCR) was performed to detect the relative expression of miR-146b-5p.All neonates in the HIE group received standardized nursing interventions,including therapeutic hypothermia care,vital sign monitoring, neurological function protection nursing and so on.After 1 year of follow-up,there was one case of loss to follow-up.The patients were divided into favorable prognosis subgroup(70 cases) and poor prognosis subgroup(24 cases).The correlations of the three indicators with disease severity,nursing evaluation and long-term prognosis were analyzed.

Serum IL-23 and TNF-α levels were significantly higher,while the relative expression of miR-146b-5p was markedly lower in the HIE group compared with the control group(P<0.05).The levels of IL-23,TNF-α and miR-146b-5p were significantly correlated with the severity of HIE(P<0.05).Neonates with poor prognosis exhibited elevated IL-23 and TNF-α levels as well as reduced miR-146b-5p expression relative to those with favorable prognosis(P<0.05).After adjusting for confounding factors,IL-23,TNF-α and miR-146b-5p remained independently correlated with neonatal prognosis(P<0.05).Receiver operating characteristic(ROC) curve analysis revealed that the area under the curve(AUC) of combined detection of IL-23,TNF-α and miR-146b-5p for predicting neonatal prognosis reached 0.945,which possessed significantly superior predictive efficiency compared with single indicator detection(P<0.05).

Serum IL-23,TNF-α,and miR-146b-5p could be used as objective quantitative indicators for the assessment and stratification of the condition of full-term neonates with HIE.The combined detection of these three could improve the accuracy of predicting the prognosis risk,in order to provide scientific support for optimizing nursing plans,to allocate nursing resources,and to improve the long-term outcome of the children.