Holcroft Cynthia J, Blakemore Karin J, Allen Marilee, Graham Ernest M
Department of Gynecology-Obstetrics, Johns Hopkins University School of Medicine, Baltimore 21287, Maryland, USA.
Obstet Gynecol. 2003 Jun;101(6):1249-53. doi: 10.1016/s0029-7844(03)00354-5.
To identify risk factors predictive of neurologic morbidity in very low birth weight (VLBW) infants.
This is a case-control study of all infants weighing 1500 g or less admitted to a single tertiary neonatal intensive care unit between April 1999 and December 2001. The case group were those neonates with neurologic morbidity including intraventricular hemorrhage, seizures, hydrocephalus, and periventricular leukomalacia. The control group were those without neurologic morbidity. Wilcoxon rank-sum, Fisher exact test, chi(2), and univariate and stepwise multiple logistic regression were performed, with P < 0.05 considered significant.
Of 213 VLBW infants, 77 had neurologic morbidity: 61 had intraventricular hemorrhage, eight had seizures, 13 had hydrocephalus, and nine had periventricular leukomalacia. Several infants had more than one morbidity. Gestational age (odds ratio [OR] 0.95; 95% confidence interval [CI] 0.94, 0.96; P <.005), birth weight (OR 0.62; 95% CI 0.49, 0.79; P <.005), and neonatal infection (OR 1.36; 95% CI 1.17, 1.58; P <.005) were highly associated with neurologic morbidity. There was no difference in mean umbilical arterial cord pH (7.25 +/- 0.15, 7.28 +/- 0.09, P =.45) or base excess (-3.8 +/- 4.8 mEq/L, -2.3 +/- 3.0, P =.10). Only three of 52 infants (5.8%) in the case group had an umbilical arterial pH of less than 7.
Prematurity and neonatal infection were the dominant factors associated with neurologic morbidity in VLBW infants. Intrapartum acidosis occurred in less than 6% of those with neurologic morbidity.
确定极低出生体重（VLBW）婴儿神经功能障碍的预测风险因素。
这是一项病例对照研究，研究对象为1999年4月至2001年12月期间入住单一三级新生儿重症监护病房的所有体重1500克及以下的婴儿。病例组为患有神经功能障碍的新生儿，包括脑室内出血、癫痫、脑积水和脑室周围白质软化。对照组为无神经功能障碍的婴儿。采用Wilcoxon秩和检验、Fisher精确检验、卡方检验以及单因素和逐步多因素逻辑回归分析，P<0.05认为具有统计学意义。
213例VLBW婴儿中，77例患有神经功能障碍：61例发生脑室内出血，8例出现癫痫，13例患有脑积水，9例有脑室周围白质软化。部分婴儿存在不止一种疾病。胎龄（优势比[OR]0.95；95%置信区间[CI]0.94，0.96；P<0.005）、出生体重（OR 0.62；95%CI 0.49，0.79；P<0.005）和新生儿感染（OR 1.36；95%CI 1.17，1.58；P<0.005）与神经功能障碍高度相关。脐动脉血平均pH值（7.25±0.15，7.28±0.09，P = 0.45）或碱剩余（-3.8±4.8 mEq/L，-2.3±3.0，P = 0.10）无差异。病例组52例婴儿中仅有3例（5.8%）脐动脉血pH值低于7。
早产和新生儿感染是VLBW婴儿神经功能障碍的主要相关因素。神经功能障碍患儿中，产时酸中毒发生率低于6%。
