Alexander J M, McIntire D M, Leveno K J
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235-9032, USA.
Obstet Gynecol. 1999 Aug;94(2):274-8. doi: 10.1016/s0029-7844(99)00256-2.
To assess the effects of clinical chorioamnionitis and labor complications on short-term neonatal morbidity, including seizures.
This was a retrospective cohort study of all live-born term infants who weighed more than 2500 g delivered between 1988 and 1997 at Parkland Memorial Hospital, Dallas, Texas. Infant outcomes were compared between women with and without clinical diagnoses of chorioamnionitis. Chorioamnionitis was based on maternal fever of 38C or greater with supporting clinical evidence including fetal tachycardia, uterine tenderness, and malodorous infant.
A total of 101,170 term infants were analyzed, 5144 (5%) of whom were born to women with chorioamnionitis. Apgar scores of 3 or less at 5 minutes, umbilical artery pH of 7.0 or less, delivery-room intubation, sepsis, pneumonia, seizures in the first 24 hours, and meconium aspiration syndrome were all increased in infants exposed to chorioamnionitis. After adjustment for confounding factors, including route of delivery and length of labor, chorioamnionitis remained significantly associated with intubation in the delivery room (odds ratio [OR] 2.0; 95% confidence interval [CI] 1.5, 2.6), pneumonia (OR 2.2; 95% CI 1.7, 2.8), and sepsis (OR 2.9; 95% CI 2.1, 4.1). Short-term neurologic morbidity, manifest as seizures, was not related to maternal infection during labor, but was significantly related to other labor complications.
The main short-term neonatal consequence of chorioamnionitis is infection. Short-term neurologic morbidity in infants is related to labor complications and not chorioamnionitis per se.
评估临床绒毛膜羊膜炎及分娩并发症对新生儿短期发病率的影响，包括癫痫发作。
这是一项对1988年至1997年在得克萨斯州达拉斯市帕克兰纪念医院出生的所有体重超过2500克的足月活产婴儿进行的回顾性队列研究。比较有和没有临床诊断绒毛膜羊膜炎的产妇所生婴儿的结局。绒毛膜羊膜炎的诊断依据为产妇体温达到或超过38℃，并有支持性临床证据，包括胎儿心动过速、子宫压痛和婴儿有异味。
共分析了101170例足月婴儿，其中5144例（5%）的母亲患有绒毛膜羊膜炎。暴露于绒毛膜羊膜炎的婴儿在出生后5分钟时阿氏评分≤3分、脐动脉血pH值≤7.0、在产房进行插管、败血症、肺炎、出生后24小时内癫痫发作及胎粪吸入综合征的发生率均有所增加。在对包括分娩方式和产程长度等混杂因素进行校正后，绒毛膜羊膜炎仍与产房插管（比值比[OR]2.0；95%置信区间[CI]1.5，2.6）、肺炎（OR 2.2；95%CI 1.7，2.8）和败血症（OR 2.9；95%CI 2.1，4.1）显著相关。表现为癫痫发作的短期神经疾病发病率与分娩期间的母体感染无关，但与其他分娩并发症显著相关。
绒毛膜羊膜炎的主要短期新生儿后果是感染。婴儿的短期神经疾病发病率与分娩并发症有关，而非绒毛膜羊膜炎本身。
