Sarkar Subrata, Kaplan Cynthia, Wiswell Thomas E, Spitzer Alan R
Division of Neonatology, University of Michigan, Ann Arbor, MI 48109-0254, USA.
J Perinatol. 2005 Dec;25(12):749-52. doi: 10.1038/sj.jp.7211399.
To test the hypothesis that histological chorioamnionitis (CA) is not associated with increased risk of early onset intraventricular hemorrhage (IVH).
Clinical data were prospectively collected for 62 consecutive neonates born before 28 weeks of gestation. Placental histology for CA was performed by a pathologist unaware of the head ultrasound scan (HUS) results. The first HUS was obtained by 30 minutes of life. Follow-up HUS were performed before 24 hours and again at 48 to 72 postnatal hours of life. An IVH (grade I to IV) at less than 72 hours of life was deemed an early hemorrhage.
Nine of the 62 (14.5%) infants had early onset IVH. In all, 29 infants were born to women with histological evidence of CA; 33 infants did not have CA. Infants did not differ in birth weight, gestational age, sex, cord blood pH, 5-minute Apgar score of <7, cesarean delivery, prenatal use of steroids, administration of tocolytics, need for resuscitation, presence of pneumothorax, platelet count at birth, or use of surfactant. Early IVH rates (3/29 in CA vs 6/33 in non-CA) were similar (p=0.48). Two infants in each group with early IVH died before 2 weeks of age. Five additional infants from the CA group developed IVH at more than 72 postnatal hours of life (late onset IVH), and two of those infants progressed to develop periventricular leukomalacia (PVL). In contrast, only three non-CA infants had late IVH and none developed PVL. Logistic regression confirmed that no perinatal variables including CA were associated with early onset IVH.
Chorioamnionitis is not associated with increased risk of early IVH.
检验组织学绒毛膜羊膜炎（CA）与早发型脑室内出血（IVH）风险增加无关这一假设。
前瞻性收集了62例孕周小于28周的连续出生新生儿的临床资料。由一名不知晓头部超声扫描（HUS）结果的病理学家对胎盘进行CA组织学检查。出生后30分钟内进行首次HUS检查。在出生后24小时之前及出生后48至72小时再次进行随访HUS检查。出生后72小时内发生的IVH（I至IV级）被视为早期出血。
62例婴儿中有9例（14.5%）发生早发型IVH。总体而言，29例婴儿的母亲有CA的组织学证据；33例婴儿没有CA。婴儿在出生体重、孕周、性别、脐血pH值、5分钟阿氏评分<7、剖宫产、产前使用类固醇、使用宫缩抑制剂、复苏需求、气胸的存在、出生时血小板计数或使用表面活性剂方面无差异。早期IVH发生率（CA组为3/29，非CA组为6/33）相似（p=0.48）。每组中有2例发生早发型IVH的婴儿在2周龄前死亡。CA组另有5例婴儿在出生后72小时后发生IVH（迟发型IVH），其中2例婴儿进展为脑室周围白质软化（PVL）。相比之下，非CA组只有3例婴儿发生迟发型IVH，且无婴儿发生PVL。逻辑回归证实，包括CA在内的围产期变量与早发型IVH均无关联。
绒毛膜羊膜炎与早发型IVH风险增加无关。
