Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI.
Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
J Pediatr. 2014 May;164(5):1005-1011.e3. doi: 10.1016/j.jpeds.2014.01.036. Epub 2014 Feb 28.
To determine whether risk factors associated with grade 2-4 intraventricular hemorrhage (IVH) differs between infants of African ancestry and white infants.
Inborn, appropriate for gestational age infants with birth weight 500-1250 g and exposure to at least 1 dose of antenatal steroids were enrolled in 24 neonatal intensive care units. Cases had grade 2-4 IVH and controls matched for site, race, and birth weight range had 2 normal ultrasounds read centrally. Multivariate logistic regression modeling identified factors associated with IVH across African ancestry and white race.
Subjects included 579 African ancestry or white race infants with grade 2-4 IVH and 532 controls. Mothers of African ancestry children were less educated, and white case mothers were more likely to have more than 1 prenatal visit and multiple gestation (P ≤ .01 for all). Increasing gestational age (P = .01), preeclampsia (P < .001), complete antenatal steroid exposure (P = .02), cesarean delivery (P < .001), and white race (P = .01) were associated with decreased risk for IVH. Chorioamnionitis (P = .01), 5-minute Apgar score <3 (P < .004), surfactant use (P < .001), and high-frequency ventilation (P < .001) were associated with increased risk for IVH. Among African ancestry infants, having more than 1 prenatal visit was associated with decreased risk (P = .02). Among white infants, multiple gestation was associated with increased risk (P < .001), and higher maternal education was associated with decreased risk (P < .05).
The risk for IVH differs between infants of African ancestry and white infants, possibly attributable to both race and health care disparities.
确定与 2-4 级脑室内出血（IVH）相关的风险因素在非裔和白人婴儿之间是否存在差异。
本研究纳入了 24 个新生儿重症监护病房的出生体重为 500-1250 克、至少接受过 1 剂产前类固醇治疗的宫内、适合胎龄的婴儿。病例组有 2-4 级 IVH，对照组则按部位、种族和出生体重范围匹配，且有 2 次经中心读取的正常超声。多变量逻辑回归模型确定了非裔和白种人群中与 IVH 相关的因素。
共纳入 579 名非裔或白种人患有 2-4 级 IVH 的婴儿和 532 名对照组婴儿。非裔儿童的母亲受教育程度较低，而白种病例组的母亲更有可能接受多次产前检查和多胎妊娠（所有 P 值均<.01）。胎龄增加（P=.01）、子痫前期（P<.001）、完全接受产前类固醇暴露（P=.02）、剖宫产（P<.001）和白种人（P=.01）与 IVH 风险降低相关。绒毛膜羊膜炎（P=.01）、5 分钟 Apgar 评分<3（P<.004）、表面活性剂使用（P<.001）和高频通气（P<.001）与 IVH 风险增加相关。在非裔婴儿中，接受多次产前检查与风险降低相关（P=.02）。在白种婴儿中，多胎妊娠与风险增加相关（P<.001），而母亲的较高教育程度与风险降低相关（P<.05）。
非裔和白人婴儿的 IVH 风险不同，这可能归因于种族和医疗保健差异。
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