[绒毛膜羊膜炎与新生儿发病率]
[Chorioamnionitis and neonatal morbidity].
作者信息
Rocha Gustavo, Proença Elisa, Quintas Conceição, Rodrigues Teresa, Guimarães Hercília
机构信息
Serviço de Neonatologia, Departamento de Pediatria, Hospital de São João, Porto.
出版信息
Acta Med Port. 2006 May-Jun;19(3):207-12. Epub 2006 Sep 7.
INTRODUCTION
Several studies highlight the association between perinatal infection/inflammation and neonatal morbidity, mainly bronchopulmonary dysplasia and periventricular leukomalacia.
AIM
To evaluate the role of histological chorioamnionitis on the overall morbidity of preterm newborns.
METHODS
A retrospective study on preterm newborns less than 34 weeks gestational age at birth, and respective mothers, at three tertiary medical centers (Hospital de São João, Maternidade Júlio Dinis and Centro Hospitalar de Vila Nova de Gaia) in the north of Portugal, between January 2001 and December 2002. We evaluated the association between histological chorioamnionitis and the overall neonatal morbidity. The association between histological chorioamnionitis and acute (respiratory distress syndrome) and chronic (bronchopulmonary dysplasia) lung damage was also evaluated in the subgroup of less than 1000 g birthweight preterm neonates.
RESULTS
452 [ M 253 / F 217; birthweight 1440 (515-2620) g; gestational age 31 (23-33) weeks] preterm newborns were included. The association between histological chorioamnionitis and the overall neonatal morbidity was: respiratory distress syndrome OR 1.5 (95% CI 0.94-2.31); bronchopulmonary dysplasia OR 2.6 (95% CI 1.16-6.03); patent ductus arteriosus OR 2.5 (95% CI 1.17-5.44); sepsis OR 1.2 (95% CI 0.9-2.13); necrotizing enterocolitis OR 1.4 (95% CI 0.9-1.76); intraventricular hemorrhage grades III-IV OR 2.5 (1.20-5.11); cystic periventricular leukomalacia OR 3.0 (1.5-6.07); retinopathy of prematurity OR 1.4 (95% CI 0.8-1.35). The association adjusted to birthweight and gestational age was: bronchopulmonary dysplasia OR 1.2 (95% CI 0.51-2.95); patent ductus arteriosus OR 0.9 (95% CI 0.4-2.35); intraventricular hemorrhage grades III-IV OR 0.9 (95% CI 0.39-2.28); cystic periventricular leukomalacia OR 2.2 (95% CI 1.03-4.61). The association between histological chorioamnionitis and lung damage in the subgroup of less than 1000 g birthweight preterm neonates was: respiratory distress syndrome OR 0.23 (95% CI 0.01-2.51); bronchopulmonary dysplasia OR 1.61 (95% CI 0.38-6.97).
CONCLUSION
This study confirms the association between histological chorioamnionitis and cystic periventricular leukomalacia of the preterm newborn.
引言
多项研究强调围产期感染/炎症与新生儿发病之间的关联，主要是支气管肺发育不良和脑室周围白质软化。
目的
评估组织学绒毛膜羊膜炎对早产新生儿总体发病率的作用。
方法
对2001年1月至2002年12月期间在葡萄牙北部三家三级医疗中心（圣若昂医院、胡利奥·迪尼斯妇产医院和盖亚新镇中心医院）出生时胎龄小于34周的早产新生儿及其母亲进行一项回顾性研究。我们评估了组织学绒毛膜羊膜炎与新生儿总体发病率之间的关联。在出生体重小于1000g的早产新生儿亚组中，还评估了组织学绒毛膜羊膜炎与急性（呼吸窘迫综合征）和慢性（支气管肺发育不良）肺损伤之间的关联。
结果
纳入了452例[男253例/女217例；出生体重1440（515 - 2620）g；胎龄31（23 - 33）周]早产新生儿。组织学绒毛膜羊膜炎与新生儿总体发病率之间的关联为：呼吸窘迫综合征，比值比1.5（95%置信区间0.94 - 2.31）；支气管肺发育不良，比值比2.6（95%置信区间1.16 - 6.03）；动脉导管未闭，比值比2.5（95%置信区间1.17 - 5.44）；败血症，比值比1.2（95%置信区间0.9 - 2.13）；坏死性小肠结肠炎，比值比1.4（95%置信区间0.9 - 1.76）；Ⅲ - Ⅳ级脑室内出血，比值比2.5（1.20 - 5.11）；脑室周围囊性白质软化，比值比3.0（1.5 - 6.07）；早产儿视网膜病变，比值比1.4（95%置信区间0.8 - 1.35）。根据出生体重和胎龄调整后的关联为：支气管肺发育不良，比值比1.2（95%置信区间0.51 - 2.95）；动脉导管未闭，比值比0.9（95%置信区间0.4 - 2.35）；Ⅲ - Ⅳ级脑室内出血，比值比0.9（95%置信区间0.39 - 2.28）；脑室周围囊性白质软化，比值比2.2（95%置信区间1.03 - 4.61）。在出生体重小于1000g的早产新生儿亚组中，组织学绒毛膜羊膜炎与肺损伤之间的关联为：呼吸窘迫综合征，比值比0.23（95%置信区间0.01 - 2.51）；支气管肺发育不良，比值比1.61（95%置信区间0.38 - 6.97）。
结论
本研究证实了组织学绒毛膜羊膜炎与早产新生儿脑室周围囊性白质软化之间的关联。
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