Shy K K, Luthy D A, Bennett F C, Whitfield M, Larson E B, van Belle G, Hughes J P, Wilson J A, Stenchever M A
Department of Obstetrics and Gynecology, University of Washington, Seattle 98195.
N Engl J Med. 1990 Mar 1;322(9):588-93. doi: 10.1056/NEJM199003013220904.
In a multicenter, randomized clinical trial, we assessed the early neurologic development of 93 children born prematurely whose heart rates were monitored electronically during delivery and compared it with that of 96 children born prematurely whose heart rates were periodically monitored by auscultation. All the children were singletons with cephalic presentation, and all weighed less than or equal to 1750 g at birth. The mental and psychomotor indexes of the Bayley Scales of Infant Development (standardized mean score +/- SD, 100 +/- 16) and a formal neurologic examination were administered at three follow-up visits (at 4, 8, and 18 months of age, corrected for gestational age). At 18 months, the mean mental-development scores in the groups receiving electronic fetal monitoring and periodic auscultation were 100.5 +/- 2.4 and 104.9 +/- 1.8, respectively (P greater than 0.1). The mean psychomotor-development scores in the two groups at 18 months were 94.0 +/- 2.4 and 98.3 +/- 1.8, respectively (P greater than 0.1). The incidence of cerebral palsy was higher in the electronically monitored group--20 percent as compared with 8 percent in the group that was monitored by auscultation (P less than 0.03). In the electronic-fetal-monitoring group (but not in the periodic-auscultation group), the risk of cerebral palsy increased with the duration of abnormal fetal-heart-rate patterns, as assessed by retrospective review (chi 2 trend = 12.71, P less than 0.001). The median time to delivery after the diagnosis of abnormal fetal-heart-rate patterns was 104 minutes with electronic fetal monitoring, as compared with 60 minutes with periodic auscultation. We conclude that as compared with a structured program of periodic auscultation, electronic fetal monitoring does not result in improved neurologic development in children born prematurely.
在一项多中心随机临床试验中，我们评估了93名早产儿童的早期神经发育情况，这些儿童在分娩期间通过电子方式监测心率，并将其与96名早产儿童进行比较，后者通过听诊定期监测心率。所有儿童均为单胎头位分娩，出生时体重均小于或等于1750克。在三次随访（矫正胎龄4、8和18个月时）时，采用贝利婴儿发育量表（标准化平均分±标准差，100±16）的智力和心理运动指数以及正式的神经学检查。18个月时，接受电子胎儿监护和定期听诊的两组儿童的平均智力发育得分分别为100.5±2.4和104.9±1.8（P>0.1）。两组在18个月时的平均心理运动发育得分分别为94.0±2.4和98.3±1.8（P>0.1）。电子监护组的脑瘫发病率较高，为20%，而听诊监测组为8%（P<0.03）。通过回顾性分析评估，在电子胎儿监护组（而非定期听诊组）中，脑瘫风险随异常胎儿心率模式持续时间的增加而增加（卡方趋势=12.71，P<0.001）。诊断异常胎儿心率模式后至分娩的中位时间，电子胎儿监护为104分钟，而定期听诊为60分钟。我们得出结论，与结构化的定期听诊方案相比，电子胎儿监护并不能改善早产儿童的神经发育。
