Suarez R D, Grobman W A, Parilla B V
Section of Maternal-Fetal Medicine and the Department of Obstetrics and Gynecology, Northwestern Memorial Hospital and Evanston Hospital, Northwestern University Medical School, Chicago, Illinois, USA.
Obstet Gynecol. 2001 Jun;97(6):921-5. doi: 10.1016/s0029-7844(01)01356-4.
To determine the association between indomethacin tocolysis and neonatal intraventricular hemorrhage.
Fifty-six preterm neonates with intraventricular hemorrhage were matched by gestational age with neonates (n = 224) without this morbidity. Maternal and neonatal charts were reviewed to ascertain the type of tocolytic exposure experienced by the neonate. Other maternal and neonatal demographic and outcome data were also abstracted. Results were analyzed using the Student t test, chi(2) analysis, and multivariable logistic regression. The number of studied subjects provided 80% power to determine if antenatal exposure to indomethacin was twice as likely among infants with intraventricular hemorrhage.
Univariate analysis revealed that there were no significant differences between the study and control groups with respect to maternal age, parity, or betamethasone exposure. Infants with intraventricular hemorrhage were significantly more likely to be born at an earlier gestational age, a lower birth weight, after maternal chorioamnionitis, after vaginal delivery, and after exposure to either indomethacin alone or a combination of indomethacin and magnesium. Additionally, their neonatal course was significantly more likely to be complicated by sepsis and respiratory distress syndrome. In a multivariable logistic model, only gestational age, chorioamnionitis, vaginal delivery, and respiratory distress syndrome continued to be significantly associated with intraventricular hemorrhage. Indomethacin exposure, either as single-agent (adjusted odds ratio 1.3, 95% confidence interval 0.5, 3.3) or combination tocolytic therapy (adjusted odds ratio 2.0, 95% confidence interval 0.8, 4.8), was not significantly associated with intraventricular hemorrhage.
Indomethacin tocolysis is not associated with an increased risk of intraventricular hemorrhage.
确定吲哚美辛保胎与新生儿脑室内出血之间的关联。
56例患有脑室内出血的早产儿按胎龄与未患此病的新生儿（n = 224例）进行匹配。查阅产妇和新生儿病历，以确定新生儿所经历的保胎药物类型。还提取了其他产妇和新生儿的人口统计学及结局数据。使用学生t检验、卡方分析和多变量逻辑回归分析结果。所研究的受试者数量提供了80%的检验效能，以确定脑室内出血婴儿产前暴露于吲哚美辛的可能性是否为未患此病婴儿的两倍。
单因素分析显示，研究组与对照组在产妇年龄、产次或倍他米松暴露方面无显著差异。患有脑室内出血的婴儿更有可能在更早的胎龄、更低的出生体重时出生，更有可能在产妇绒毛膜羊膜炎后、阴道分娩后以及暴露于单独的吲哚美辛或吲哚美辛与镁的联合用药后出生。此外，他们的新生儿病程更有可能并发败血症和呼吸窘迫综合征。在多变量逻辑模型中，只有胎龄、绒毛膜羊膜炎、阴道分娩和呼吸窘迫综合征继续与脑室内出血显著相关。吲哚美辛暴露，无论是单药治疗（调整后的比值比为1.3，95%置信区间为0.5至3.3）还是联合保胎治疗（调整后的比值比为2.0，95%置信区间为0.8至4.8），均与脑室内出血无显著关联。
吲哚美辛保胎与脑室内出血风险增加无关。
