Linder Nechama, Linder Ido, Fridman Elena, Kouadio Frank, Lubin Daniel, Merlob Paul, Yogev Yariv, Melamed Nir
Department of Neonatology and.
J Matern Fetal Neonatal Med. 2013 Oct;26(15):1491-5. doi: 10.3109/14767058.2013.789850. Epub 2013 Apr 30.
The ability to predict birth trauma (BT) based on the currently recognized risk factors is limited and there is little information regarding the short-term neonatal outcome following BT. We aimed to identify risk factors for BT and to evaluate the effect of BT on short-term neonatal outcome.
A retrospective, cohort, case-control study of all cases of BT in a single tertiary center (1986-2009). The control group included the two subsequent full-term singleton neonates who did not experienced BT. Short-term neonatal outcome was compared between the groups including Apgar scores, NICU admission, duration of hospitalization and neurologic, respiratory and metabolic morbidity.
Of the 118 280 singleton full-term newborns delivered during the study period, 2874 were diagnosed with BT (24.3/1000). The most frequent types of BT were scalp injuries (63.9%, 15.5/1000) and clavicular fracture (32.1%, 7.7/1000). The following factors were found to be independent risk factors for BT: instrumental delivery (OR 7.5, 95% CI 6.3-8.9), birth weight, delivery during risk hours, parity, maternal age and neonatal head circumference. Cesarean delivery was the only factor protective of BT (OR 0.2, 95% CI 0.2-0.3). Neonates in the study group had a prolonged length of hospital stay (3.3 versus 2.7 d, p = 0.001), were more likely to be admitted to the NICU (3.9% versus 1.9%, p < 0.001), and had a higher rate of jaundice (11.9% versus 7.1%, p < 0.001) and neurological morbidity (4.7% versus 2.3%, p < 0.001).
Instrumental delivery appears to be responsible for most cases of neonatal BT.
基于目前公认的危险因素预测分娩创伤（BT）的能力有限，且关于BT后短期新生儿结局的信息较少。我们旨在确定BT的危险因素，并评估BT对短期新生儿结局的影响。
对一家三级中心（1986 - 2009年）所有BT病例进行回顾性队列病例对照研究。对照组包括随后出生的两名未经历BT的足月单胎新生儿。比较两组之间的短期新生儿结局，包括阿氏评分、入住新生儿重症监护病房（NICU）情况、住院时间以及神经、呼吸和代谢方面的发病率。
在研究期间分娩的118280名单胎足月新生儿中，2874例被诊断为BT（24.3/1000）。BT最常见的类型是头皮损伤（63.9%，15.5/1000）和锁骨骨折（32.1%，7.7/1000）。发现以下因素是BT的独立危险因素：器械助产（比值比[OR] 7.5，95%置信区间[CI] 6.3 - 8.9）、出生体重、危险时段分娩、产次、产妇年龄和新生儿头围。剖宫产是唯一对BT有保护作用的因素（OR 0.2，95% CI 0.2 - 0.3）。研究组新生儿住院时间延长（3.3天对2.7天，p = 0.001），更有可能入住NICU（3.9%对1.9%，p < 0.001），黄疸发生率更高（11.9%对7.1%，p < 0.001）和神经方面的发病率更高（4.7%对2.3%，p < 0.001）。
器械助产似乎是大多数新生儿BT病例的原因。
