新生儿重度酸中毒的危险因素。

Risk factors for severe neonatal acidosis.

机构信息

Department of Obstetrics and Gynecology, Sainte-Justine Hospital, Montreal, Quebec, Canada.

出版信息

Obstet Gynecol. 2011 Oct;118(4):818-23. doi: 10.1097/AOG.0b013e31822c9198.

DOI:10.1097/AOG.0b013e31822c9198

PMID:21934444

Abstract

OBJECTIVE

Neonatal asphyxia may have severe consequences in term newborns. Our purpose was to identify possible risk factors of severe acidosis during pregnancy and labor.

METHODS

In a case-control study from January 2003 to December 2008 in three university perinatal centers (two French and one Canadian hospitals), we analyzed 226 women with term pregnancies complicated by severe neonatal acidosis (umbilical artery pH less than 7.00). Cases were individually matched with controls with a normal acid-base status (pH 7.15 or greater) paired by parity. Groups were compared for differences in maternal, obstetric, and fetal characteristics. Univariable and logistic conditional regression were used to identify possible risk factors.

RESULTS

Among 46,722 births after 22 weeks, 6,572 preterm births and 829 stillbirths or terminations of pregnancy were excluded. From the 39,321 live term births, 5.30% of pH values were unavailable. Severe acidosis complicated 0.63% of 37,235 term structurally normal pregnancies. By using multivariate conditional regression, maternal age 35 years or older (35.0% compared with 15.5%; odds ratio [OR] 5.58, 95% confidence interval [CI] 2.51-12.40), prior neonatal death (3.5% compared with 0%), prior cesarean delivery (24.7% compared with 6.6%; OR 4.08, 95% CI 1.71-9.72) even after excluding cases of uterine rupture, general anesthesia (8.4 compared with 0.9%; OR 8.04, 95% CI 1.26-50.60), thick meconium (6.4% compared with 2.8%; OR 5.81, 95% CI 1.72-19.66), uterine rupture (4.4% compared with 0%), and abnormal fetal heart rate (66.1% compared with 19.8%; OR 8.77, 95% CI 3.72-20.78) were independent risk factors of severe neonatal acidosis.

CONCLUSION

Prior cesarean delivery, maternal age 35 years or older, prior neonatal death, general anesthesia, thick meconium, uterine rupture, and abnormal fetal heart rate are independent risk factors of severe neonatal acidosis.

LEVEL OF EVIDENCE

II.

摘要

目的

新生儿窒息可能对足月新生儿产生严重后果。我们的目的是确定妊娠和分娩期间严重酸中毒的可能危险因素。

方法

在 2003 年 1 月至 2008 年 12 月期间，在三个大学围产中心（两个法国医院和一个加拿大医院）进行了一项病例对照研究，我们分析了 226 名足月妊娠伴严重新生儿酸中毒（脐动脉 pH 值小于 7.00）的孕妇。病例组与 pH 值正常（7.15 或更高）的对照组按产次进行个体匹配。比较两组间的母体、产科和胎儿特征差异。采用单变量和逻辑条件回归来确定可能的危险因素。

结果

在 22 周后出生的 46722 例分娩中，排除了 6572 例早产、829 例死产或妊娠终止。在 39321 例足月活产中，5.30%的 pH 值不可用。严重酸中毒合并 0.63%的 37235 例足月结构正常妊娠。采用多变量条件回归，母亲年龄 35 岁或以上（35.0%比 15.5%；比值比[OR]5.58，95%置信区间[CI]2.51-12.40）、新生儿死亡史（3.5%比 0%；OR 5.58，95%CI 2.51-12.40）、既往剖宫产史（24.7%比 6.6%；OR 4.08，95%CI 1.71-9.72），即使排除了子宫破裂、全身麻醉（8.4%比 0.9%；OR 8.04，95%CI 1.26-50.60）、胎粪污染（6.4%比 2.8%；OR 5.81，95%CI 1.72-19.66）、子宫破裂（4.4%比 0%）和胎儿心率异常（66.1%比 19.8%；OR 8.77，95%CI 3.72-20.78）是严重新生儿酸中毒的独立危险因素。