中度和晚期早产儿中的脑瘫

Cerebral palsy among children born moderately and late preterm.

作者信息

Hirvonen Mikko, Ojala Riitta, Korhonen Päivi, Haataja Paula, Eriksson Kai, Gissler Mika, Luukkaala Tiina, Tammela Outi

机构信息

Departments of Pediatrics, and Tampere Center for Child Health Research, and Central Finland Health Care District, Jyväskylä, Finland;

Departments of Pediatrics, and Tampere Center for Child Health Research, and.

出版信息

Pediatrics. 2014 Dec;134(6):e1584-93. doi: 10.1542/peds.2014-0945.

DOI:10.1542/peds.2014-0945

PMID:25422011

Abstract

OBJECTIVE

To compare the incidence of and risk factors for cerebral palsy (CP) in moderately preterm (MP) (32(+0)-33(+6) weeks) and late preterm (LP) (34(+0)-36(+6) weeks) infants with those in very preterm (VP) (<32(+0) weeks) and term infants (≥37 weeks).

METHODS

The national register study included all live-born infants in Finland from 1991 to 2008. Infants who died before the age of 1 year, had any major congenital anomaly, or had missing data were excluded. A total of 1 018 302 infants were included in the analysis and they were analyzed in 4 subgroups (VP, MP, LP, and term) and 3 time periods (1991-1995, 1996-2001, and 2002-2008).

RESULTS

By the age of 7 years, 2242 children with CP were diagnosed (0.2%). CP incidence was 8.7% in the VP, 2.4% in the MP, 0.6% in the LP, and 0.1% in the term group. The risk of CP was highest in the study period 1991-1995 in all groups. Factors predictive of an increased CP risk in the MP and LP groups included resuscitation at birth (odds ratio 1.60; 95% CI 1.01-2.53 and 1.78; 1.09-2.90), antibiotic treatment during the first hospitalization (1.63; 1.08-2.45 and 1.67; 1.13-2.44), 1-minute Apgar score <7 (1.70; 1.15-2.52 and 1.80; 1.21-2.67) and intracranial hemorrhage (7.18; 3.60-14.3 and 12.8; 5.58-29.2).

CONCLUSIONS

The incidence of CP is higher in LP and MP infants compared with term infants. There is a nonlinear decrease in incidence over time and with increasing gestational age.

摘要

目的

比较中度早产（MP）（32⁺⁰ - 33⁺⁶周）和晚期早产（LP）（34⁺⁰ - 36⁺⁶周）婴儿与极早产（VP）（<32⁺⁰周）和足月儿（≥37周）脑瘫（CP）的发病率及危险因素。

方法

全国登记研究纳入了1991年至2008年芬兰所有活产婴儿。排除1岁前死亡、有任何重大先天性异常或数据缺失的婴儿。共有1018302名婴儿纳入分析，他们被分为4个亚组（VP、MP、LP和足月儿）以及3个时间段（1991 - 1995年、1996 - 2001年和2002 - 2008年）进行分析。

结果

到7岁时，共诊断出2242例脑瘫患儿（0.2%）。VP组脑瘫发病率为8.7%，MP组为2.4%，LP组为0.6%，足月儿组为0.1%。所有组在1991 - 1995年研究期间脑瘫风险最高。MP组和LP组中预测脑瘫风险增加的因素包括出生时复苏（比值比1.60；95%可信区间1.01 - 2.53和1.78；1.09 - 2.90）、首次住院期间抗生素治疗（1.63；1.08 - 2.45和1.67；1.13 - 2.44）、1分钟阿氏评分<7（1.70；1.15 - 2.52和1.80；1.21 - 2.67）以及颅内出血（7.18；3.60 - 14.3和12.8；5.58 - 29.2）。