Kadooka Mizuho, Kato Hiromi, Kato Akihiko, Ibara Satoshi, Minakami Hisanori, Maruyama Yuko
Division of Neonatology, Perinatal Medical center, Kagoshima City Hospital, Kagoshima, Japan.
Division of Anesthesiology, Nanpuh Hospital, Kagoshima City, Kagoshima, Japan.
Early Hum Dev. 2014 Sep;90(9):431-4. doi: 10.1016/j.earlhumdev.2014.05.010. Epub 2014 Jun 22.
Fetomaternal hemorrhage (FMH) can cause severe morbidity. However, perinatal risk factors for long-term poor outcome due to FMH have not been extensively studied.
To determine which FMH infants are likely to have neurological sequelae.
A single-center retrospective observational study. Perinatal factors, including demographic characteristics, Kleihauer-Betke test, blood gas analysis, and neonatal blood hemoglobin concentration ([Hb]), were analyzed in association with long-term outcomes.
All 18 neonates referred to a Neonatal Intensive Care Unit of Kagoshima City Hospital and diagnosed with FMH during a 15-year study period. All had a neonatal [Hb] <7.5g/dL and 15 of 17 neonates tested had Kleihauer-Betke test result >4.0%.
Poor long-term outcome was defined as any of the following determined at 12 month old or more: cerebral palsy, mental retardation, attention deficit/hyperactivity disorder, and epilepsy.
Nine of the 18 neonates exhibited poor outcomes. Among demographic characteristics and blood variables compared between two groups with poor and favorable outcomes, significant differences were observed in [Hb] (3.6±1.4 vs. 5.4±1.1g/dL, P=0.01), pH (7.09±0.11 vs. 7.25±0.13, P=0.02) and base deficits (17.5±5.4 vs. 10.4±6.0mmol/L, P=0.02) in neonatal blood, and a number of infants with [Hb]≤4.5g/dL (78%[7/9] vs. 22%[2/9], P=0.03), respectively. The base deficit in neonatal arterial blood increased significantly with decreasing neonatal [Hb].
Severe anemia causing severe base deficit is associated with neurological sequelae in FMH infants.
胎儿-母体出血（FMH）可导致严重发病。然而，FMH导致长期不良结局的围产期危险因素尚未得到广泛研究。
确定哪些FMH婴儿可能有神经后遗症。
单中心回顾性观察研究。分析围产期因素，包括人口统计学特征、克列豪尔-贝特克试验、血气分析和新生儿血血红蛋白浓度（[Hb]）与长期结局的关系。
在15年的研究期间，所有转诊至鹿儿岛市医院新生儿重症监护病房并被诊断为FMH的18例新生儿。所有新生儿的新生儿期[Hb]<7.5g/dL，17例接受检测的新生儿中有15例克列豪尔-贝特克试验结果>4.0%。
长期不良结局定义为12月龄及以上出现以下任何一种情况：脑瘫、智力发育迟缓、注意力缺陷/多动障碍和癫痫。
18例新生儿中有9例出现不良结局。在不良结局组和良好结局组之间比较的人口统计学特征和血液变量中，新生儿血中的[Hb]（3.6±1.4 vs. 5.4±1.1g/dL，P=0.01）、pH（7.09±0.11 vs. 7.25±0.13，P=0.02）和碱缺失（17.5±5.4 vs. 10.4±6.0mmol/L，P=0.02）以及[Hb]≤4.5g/dL的婴儿数量（78%[7/9] vs. 22%[2/9]，P=0.03）存在显著差异。新生儿动脉血碱缺失随新生儿[Hb]降低而显著增加。
导致严重碱缺失的严重贫血与FMH婴儿的神经后遗症有关。
