Nelson K B, Leviton A
Neuroepidemiology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Md.
Am J Dis Child. 1991 Nov;145(11):1325-31. doi: 10.1001/archpedi.1991.02160110117034.
In the literature on neonatal encephalopathy, the pervasive assumption is that once infants with major malformations or infections have been excluded, most of the remaining cases are due to birth asphyxia. Assessing the proportion of neonatal encephalopathy that is due to asphyxia during birth is difficult because of problems in defining asphyxia and neonatal encephalopathy and in recognizing the cause of neonatal neurologic illness. Available evidence indicates that neonatal neurologic signs are not strongly related to obstetric complications, signs of fetal distress, or biochemical markers usually considered to indicate perinatal asphyxia. Most studies that have sought positive evidence of independent markers of intrapartum asphyxia have found them to be absent in a large majority of neurologically symptomatic neonates. We conclude that the proportion of neonatal encephalopathy that is asphyxial in origin is not known but warrants examination, especially in view of the probable need in the near future to identify, on the basis of evidence available in the first hour or so of life, suitable candidates for clinical trials of powerful but risky treatments of birth asphyxia.
在关于新生儿脑病的文献中，普遍的假设是，一旦排除患有严重畸形或感染的婴儿，其余大多数病例都归因于出生时窒息。由于在定义窒息和新生儿脑病以及识别新生儿神经疾病病因方面存在问题，评估出生时窒息所致新生儿脑病的比例很困难。现有证据表明，新生儿神经体征与产科并发症、胎儿窘迫迹象或通常被认为表明围产期窒息的生化标志物没有密切关系。大多数寻求产时窒息独立标志物阳性证据的研究发现，绝大多数有神经症状的新生儿中不存在这些标志物。我们得出结论，源于窒息的新生儿脑病比例尚不清楚，但值得研究，特别是鉴于在不久的将来可能需要根据出生后一小时左右可获得的证据，确定适合进行强力但有风险的出生窒息治疗临床试验的合适人选。
