De Felice Claudio, Leoni Licia, Tommasini Enrica, Tonni Gabriele, Toti Paolo, Del Vecchio Antonio, Ladisa Grazia, Latini Giuseppe
Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy.
Pediatr Crit Care Med. 2008 Mar;9(2):203-8. doi: 10.1097/PCC.0b013e3181670021.
Evidence suggests increased morbidity, in particular early neonatal respiratory complications, in newborns from elective cesarean section compared with those from vaginal delivery. No reliable maternal predictors of adverse neonatal outcome at elective cesarean section are known. Here, we prospectively tested the hypothesis that a low maternal perfusion index at the baseline phase (i.e., preanesthesia) of the elective cesarean section is a predictor of early adverse neonatal respiratory outcome.
Prospective cohort study.
Operating and delivery rooms of a public health hospital with a tertiary-level neonatal intensive care unit.
Forty-four healthy pregnant women with no known risk factors undergoing elective cesarean section at term gestation.
Elective cesarean section was divided into nine phases. Analysis of pulse oximetry-derived signals (perfusion index, pulse rate, and oximetry) and systolic, diastolic, and differential blood pressure were recorded. Maternal arterial and venous newborn cord blood gas analyses and placental histology were evaluated.
Early respiratory complications (transient tachypnea of the newborn, n = 5; respiratory distress syndrome, n = 1) were observed in 13.6% (6 of 44) of the newborns. A maternal perfusion index < or = 1.9 (lower quartile) during the preanesthesia phase of the elective cesarean section was an independent predictor of early adverse neonatal respiratory outcome (odds ratio 68.0, 95% confidence interval 6.02-767.72; p < .0001).
A decreased perfusion index value in the preanesthesia phase of elective cesarean section is a maternal predictor of increased neonatal morbidity and is significantly related to subclinical placental inflammatory disease. These observations suggest the feasibility of a noninvasive pulse oximeter prenatal screening of the high-risk fetus/newborn in elective cesarean section.
有证据表明,与经阴道分娩的新生儿相比,择期剖宫产出生的新生儿发病率增加,尤其是早期新生儿呼吸并发症。目前尚不清楚择期剖宫产时预测新生儿不良结局的可靠母体因素。在此,我们前瞻性地检验了这样一个假设,即择期剖宫产基线期(即麻醉前)母体灌注指数低是早期新生儿不良呼吸结局的预测指标。
前瞻性队列研究。
一家设有三级新生儿重症监护病房的公共卫生医院的手术室和产房。
44名足月妊娠、无已知危险因素且接受择期剖宫产的健康孕妇。
将择期剖宫产分为九个阶段。记录经脉搏血氧饱和度仪得出的信号分析结果(灌注指数、脉搏率和血氧饱和度)以及收缩压、舒张压和脉压差。评估母体动脉血和静脉血、新生儿脐带血气分析结果以及胎盘组织学。
13.6%(44例中的6例)的新生儿出现早期呼吸并发症(新生儿短暂性呼吸急促,5例;呼吸窘迫综合征,1例)。择期剖宫产麻醉前阶段母体灌注指数≤1.9(下四分位数)是早期新生儿不良呼吸结局的独立预测指标(比值比68.0,95%置信区间6.02 - 767.72;p <.0001)。
择期剖宫产麻醉前阶段灌注指数降低是新生儿发病率增加的母体预测指标,且与亚临床胎盘炎症性疾病显著相关。这些观察结果表明,在择期剖宫产中对高危胎儿/新生儿进行无创脉搏血氧仪产前筛查是可行的。