极早产儿的分娩方式与脑室内出血

Method of delivery and intraventricular haemorrhage in extremely preterm infants.

作者信息

Dani Carlo, Poggi Chiara, Bertini Giovanna, Pratesi Simone, Di Tommaso Mariarosaria, Scarselli Gianfranco, Rubaltelli Firmino F

机构信息

Section of Neonatology, Department of Surgical and Medical Critical Care, Careggi University Hospital of Florence, Florence, Italy.

出版信息

J Matern Fetal Neonatal Med. 2010 Dec;23(12):1419-23. doi: 10.3109/14767051003678218. Epub 2010 Mar 18.

DOI:10.3109/14767051003678218

PMID:20236026

Abstract

OBJECTIVES

It has been reported that caesarean delivery (CD) protects against intraventricular haemorrhage (IVH) in the extremely preterm infant, but it is not known whether this effect involve the more severe grades of IVH. Thus, our aim was to confirm the correlation between the occurrence of IVH and the mode of delivery, and to evaluate this correlation for each grade of IVH.

METHODS

All infants with gestational age (GA) ≤ 28 weeks admitted to the neonatal intensive care unit of a tertiary hospital were studied for each grade IVH and major complications rate.

RESULT

We found that vaginally born infants had a higher rate of each grade of IVH, but the increase was statistically significant only for grade 3 IVH (18% vs. 2%, p < 0.0001) and all grades IVH (45% vs. 20%, p < 0.0001). Multivariate analysis demonstrated that CD (RR: 0.42, 95% CI 0.28-0.63), birth weight ≥ 800 g (RR: 0.48, 95% CI 0.32-0.73), 27-28 weeks of GA (RR: 0.38, 95% CI 0.25-0.60) and antenatal steroids (0.66, 95% CI 0.22-0.46) decrease independently the risk of developing IVH.

CONCLUSIONS

Our study demonstrates that CD decreases the risk of developing IVH in extremely preterm infants including the most severe grades of IVH.

摘要

目的

据报道，剖宫产可预防极早产儿脑室内出血（IVH），但尚不清楚这种作用是否涉及更严重级别的IVH。因此，我们的目的是确认IVH的发生与分娩方式之间的相关性，并评估各IVH级别之间的这种相关性。

方法

对一家三级医院新生儿重症监护病房收治的所有孕周（GA）≤28周的婴儿进行各IVH级别和主要并发症发生率的研究。

结果

我们发现，经阴道分娩的婴儿各IVH级别发生率较高，但仅3级IVH（18%对2%，p<0.0001）和所有级别IVH（45%对20%，p<0.0001）的增加具有统计学意义。多因素分析表明，剖宫产（RR：0.42，95%CI 0.28 - 0.63）、出生体重≥800g（RR：0.48，95%CI 0.32 - 0.73）、GA为27 - 28周（RR：0.38，95%CI 0.25 - 0.60）和产前使用类固醇（0.66，95%CI 0.22 - 0.46）可独立降低发生IVH的风险。