Meirowitz N B, Ananth C V, Smulian J C, Vintzileos A M
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Roger Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, New Jersey, USA.
Obstet Gynecol. 2001 Apr;97(4):494-8. doi: 10.1016/s0029-7844(00)01203-5.
To evaluate whether labor, in the setting of premature rupture of membranes (PROM), affects infant morbidity and mortality rates.
We derived data for this population-based cohort study from the United States national linked birth infant death data sets, comprised of singleton live births delivered between 1995 and 1997. We included women (n = 34,594) who had preterm PROM more than 12 hours and delivered between 23 and 32 weeks' gestation. Birth records were used to determine whether delivery occurred with or without labor. Infants with birth weights below the tenth percentile for gestational age were classified as small for gestational age (SGA) on the basis of a nomogram of all singleton births in the United States between 1995 and 1997. Primary outcomes were early neonatal (0-6 days), late neonatal (7-27 days), postneonatal (28-365 days), and infant death (0-365 days). Secondary outcomes included respiratory distress syndrome (RDS), assisted ventilation, and neonatal seizures. Risks of infant mortality and morbidity from labor were examined separately for SGA and non-SGA infants.
Overall rates were infant death 11.6%, RDS 15.1%, assisted ventilation 25.9%, and neonatal seizure 0.2%. Labor was associated with higher incidence of early neonatal death in SGA infants (adjusted relative risk [RR] 1.24, 95% confidence interval [CI] 1.11, 1.38) but had no effect on other outcomes. Among non-SGA infants, labor had no effect on infant death but was associated with higher rates of RDS (RR 1.15, 95% CI 1.08, 1.22) and assisted ventilation (RR 1.16, 95% CI 1.08, 1.24).
Although labor was associated with a slightly higher mortality rate in SGA infants and slightly more respiratory morbidity in non-SGA infants, recommendations regarding clinical treatment should await future clinical trials.
评估胎膜早破（PROM）情况下的分娩是否会影响婴儿发病率和死亡率。
我们从美国全国关联出生婴儿死亡数据集获取了该基于人群的队列研究的数据，该数据集包含1995年至1997年间的单胎活产。我们纳入了胎膜早破超过12小时且在妊娠23至32周之间分娩的女性（n = 34,594）。出生记录用于确定分娩是否伴有宫缩发动。根据1995年至1997年间美国所有单胎出生的列线图，出生体重低于胎龄第十百分位数的婴儿被分类为小于胎龄儿（SGA）。主要结局为早期新生儿（0 - 6天）、晚期新生儿（7 - 27天）、新生儿后期（28 - 365天）和婴儿死亡（0 - 365天）。次要结局包括呼吸窘迫综合征（RDS）、辅助通气和新生儿惊厥。分别对SGA和非SGA婴儿研究了宫缩发动导致的婴儿死亡率和发病率风险。
总体发生率为婴儿死亡11.6%、RDS 15.1%、辅助通气25.9%和新生儿惊厥0.2%。宫缩发动与SGA婴儿早期新生儿死亡发生率较高相关（调整相对风险[RR] 1.24，95%置信区间[CI] 1.11，1.38），但对其他结局无影响。在非SGA婴儿中，宫缩发动对婴儿死亡无影响，但与RDS发生率较高（RR 1.15，95% CI 1.08，1.22）和辅助通气发生率较高（RR 1.16，95% CI 1.08，1.24）相关。
尽管宫缩发动与SGA婴儿死亡率略高以及非SGA婴儿呼吸发病率略高相关，但关于临床治疗的建议应等待未来的临床试验。
