Gurbuz Ayse, Karateke Ates, Yilmaz Ufuk, Kabaca Canan
Zeynep Kamil Women's and Children's Diseases Education and Research Hospital, Istanbul, Turkey.
J Matern Fetal Neonatal Med. 2006 Mar;19(3):147-55. doi: 10.1080/14767050500476212.
To investigate the relationship between cerebral palsy (CP) and perinatal and intrapartum risk factors and markers of birth asphyxia.
This was a retrospective case-control study of 101 children with CP and 308 controls who were born at the Zeynep Kamil Hospital between 1990 and 2000. The roles of possible perinatal and intrapartum risk factors were investigated in CP development. Chi-square tests, Fisher's exact tests, Student t-tests, and regression analysis were used for statistical analysis (p < 0.05).
The only significant perinatal risk factor was neonatal weight of <2500 grams. The CP rate in the presence of solely intrapartum risk factors was estimated as 24.7% (n = 25). In 39.6% of cases, no risk factor could be identified. When regression analysis was performed, the following factors were significant: decreased beat-to-beat variability on electronic fetal monitoring (EFM) (p = 0.02), an Apgar score of <7 at 1 and 5 minutes (p = 0.02), and the necessity for neonatal intensive care unit admission (p < 0.0001).
Intrapartum risk factors were significantly more frequent in the CP group (p < 0.01). An increased cesarean section rate could not prevent CP, suggesting that the hypoxic insult that causes CP might be of chronic onset. The development of diagnostic tests to detect non-reassuring fetal status in its intrauterine life and interventions at appropriate times may decrease the CP rate.
探讨脑瘫（CP）与围产期及分娩期危险因素和出生窒息标志物之间的关系。
这是一项回顾性病例对照研究，研究对象为1990年至2000年间在泽伊内普·卡米尔医院出生的101例脑瘫患儿和308例对照。研究了可能的围产期及分娩期危险因素在脑瘫发生发展中的作用。采用卡方检验、费舍尔精确检验、学生t检验和回归分析进行统计分析（p<0.05）。
唯一显著的围产期危险因素是新生儿体重<2500克。仅存在分娩期危险因素时的脑瘫发生率估计为24.7%（n=25）。在39.6%的病例中，未发现危险因素。进行回归分析时，以下因素具有显著性：电子胎儿监护（EFM）时逐搏变异率降低（p=0.02）、1分钟和5分钟时阿氏评分<7（p=0.02）以及新生儿重症监护病房收治的必要性（p<0.0001）。
脑瘫组分娩期危险因素显著更常见（p<0.01）。剖宫产率的增加并不能预防脑瘫，这表明导致脑瘫的缺氧性损伤可能是慢性起病。开发在胎儿宫内生活中检测胎儿状况不佳的诊断试验并在适当时间进行干预可能会降低脑瘫发生率。
