Impey Lawrence W M, Greenwood Catherine E L, Black Rebecca S, Yeh Peter S-Y, Sheil Orla, Doyle Pat
Oxford Fetal Medicine Unit, Women's Centre, John Radcliffe Hospital, Oxford, England, UK.
Am J Obstet Gynecol. 2008 Jan;198(1):49.e1-6. doi: 10.1016/j.ajog.2007.06.011.
This study was undertaken to investigate the relationship among maternal intrapartum fever, neonatal acidosis, and the risk of neonatal encephalopathy.
Cohort study of pregnancies at term. Logistic regression was used to estimate the effect of maternal fever and acidosis on the risk of neonatal encephalopathy. The potential interaction between maternal fever and acidosis was included in the models.
Of 8299 women, 25 neonates (0.3%) had encephalopathy develop. These were more often born acidotic (adjusted odds ratio 11.5; 95% CI, 5.0-26.5) or after a maternal intrapartum fever (adjusted odds ratio 8.1; 95% CI, 3.5-18.6). Where both risk factors coexisted, the risk was 12.5% (adjusted odds ratio 93.9; 95% CI, 28.7-307.2). Although this effect is multiplicative, there was no evidence of statistical interaction (P = .93); the effect of maternal fever on the risk of encephalopathy was similar in infants with (adjusted odds ratio 8.7; 95% CI, 2.4-31.7) and without acidosis (adjusted odds ratio 7.4; 95% CI, 2.4-21.9).
The combination of a maternal fever with cord acidosis greatly increases the risk of neonatal encephalopathy, but there is evidence against interaction between them, suggesting that they represent 2 separate causal pathways.
本研究旨在探讨产妇分娩期发热、新生儿酸中毒与新生儿脑病风险之间的关系。
对足月妊娠进行队列研究。采用逻辑回归分析来评估产妇发热和酸中毒对新生儿脑病风险的影响。模型中纳入了产妇发热与酸中毒之间的潜在相互作用。
在8299名妇女中，有25名新生儿（0.3%）发生了脑病。这些新生儿更常出生时伴有酸中毒（校正比值比11.5；95%可信区间，5.0 - 26.5）或在产妇分娩期发热后（校正比值比8.1；95%可信区间，3.5 - 18.6）。当两种危险因素同时存在时，风险为12.5%（校正比值比93.9；95%可信区间，28.7 - 307.2）。尽管这种效应是相乘的，但没有统计学相互作用的证据（P = 0.93）；产妇发热对脑病风险的影响在伴有酸中毒（校正比值比8.7；95%可信区间，2.4 - 31.7）和不伴有酸中毒（校正比值比7.4；95%可信区间，2.4 - 21.9）的婴儿中相似。
产妇发热与脐带血酸中毒同时存在会大大增加新生儿脑病的风险，但有证据表明它们之间不存在相互作用，这表明它们代表两条独立的因果途径。
