Soraisham Amuchou S, Singhal Nalini, McMillan Douglas D, Sauve Reg S, Lee Shoo K
Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
Am J Obstet Gynecol. 2009 Apr;200(4):372.e1-6. doi: 10.1016/j.ajog.2008.11.034. Epub 2009 Feb 14.
The purpose of this study was to examine the effects of clinical maternal chorioamnionitis on morbidity and mortality rates among infants who are at < 33 weeks of gestation, adjusted for patient characteristics that included admission neonatal illness severity (Score for Neonatal Acute Physiology, version II; SNAP-II).
With multivariate logistic regression analysis, prospectively collected hospital outcomes from the Canadian Neonatal Network of singleton infants with birth gestational age of < 33 weeks and clinical chorioamnionitis were compared retrospectively with nonexposed infants.
Of 3094 infants, 477 infants (15.4%) who were exposed to clinical chorioamnionitis had significantly higher admission SNAP-II scores. Bivariate analysis revealed that the neonatal mortality rate was increased significantly in the chorioamnionitis group (10.6% vs 6.1%). Multivariate regression analysis with adjustment for illness severity indicated that chorioamnionitis was associated with an increased risk of early sepsis (odds ratio, 5.54; 95% confidence interval, 2.87-10.69) and severe intraventricular hemorrhage (odds ratio, 1.62; 95% confidence interval, 1.17-2.24) but not neonatal death.
Preterm infants who are exposed to clinical chorioamnionitis have an increased risk of early-onset sepsis and severe intraventricular hemorrhage.
本研究的目的是探讨临床产妇绒毛膜羊膜炎对孕周小于33周婴儿发病率和死亡率的影响，并根据包括入院时新生儿疾病严重程度（新生儿急性生理学评分第二版；SNAP-II）在内的患者特征进行调整。
采用多因素逻辑回归分析，对加拿大新生儿网络前瞻性收集的单胎、出生孕周小于33周且患有临床绒毛膜羊膜炎婴儿的医院结局，与未暴露婴儿进行回顾性比较。
在3094例婴儿中，477例（15.4%）暴露于临床绒毛膜羊膜炎的婴儿入院时SNAP-II评分显著更高。二元分析显示，绒毛膜羊膜炎组的新生儿死亡率显著增加（10.6%对6.1%）。对疾病严重程度进行调整的多因素回归分析表明，绒毛膜羊膜炎与早发性败血症风险增加（比值比，5.54；95%置信区间，2.87-10.69）和重度脑室内出血（比值比，1.62；95%置信区间，1.17-2.24）相关，但与新生儿死亡无关。
暴露于临床绒毛膜羊膜炎的早产儿发生早发性败血症和重度脑室内出血的风险增加。
