Girsen Anna I, Wallenstein Matthew B, Davis Alexis S, Hintz Susan R, Desai Arti K, Mansour Trina, Merritt T Allen, Druzin Maurice L, Oshiro Bryan T, Blumenfeld Yair J
a Department of Obstetrics & Gynecology , Stanford University School of Medicine , Stanford , CA , USA .
b Division of Neonatal and Developmental Medicine , Department of Pediatrics, Stanford University School of Medicine , Stanford , CA , USA .
J Matern Fetal Neonatal Med. 2016;29(15):2500-4. doi: 10.3109/14767058.2015.1090971. Epub 2015 Oct 7.
To investigate the association between meconium staining and perinatal and neonatal outcomes in pregnancies with gastroschisis.
Retrospective analysis of infants with prenatally diagnosed gastroschisis born in two academic medical centers between 2008 and 2013. Neonatal outcomes of deliveries with and without meconium staining were compared. Primary outcome was defined as any of the following: neonatal sepsis, prolonged mechanical ventilation, bowel atresia or death. Secondary outcomes were preterm delivery, preterm-premature rupture of membranes (PPROM) and prolonged hospital length of stay.
One hundred and eight infants with gastroschisis were included of which 56 (52%) had meconium staining at delivery. Infants with meconium staining had a lower gestational age at delivery (36.3 (±1.4) versus 37.0 (±1.2) weeks, p = 0.007), and a higher rate of PPROM (25% versus 8%, p = 0.03) than infants without meconium. Meconium staining was not significantly associated with the primary composite outcome or with any of its components. After adjustments, meconium staining remained significantly associated with preterm delivery at <36 weeks [odds ratio OR = 4.0, 95% confidence intervals (CI): 1.5-11.4] and PPROM (OR = 3.8, 95%CI: 1.2-14.5).
Among infants with gastroschisis, meconium staining was associated with prematurity and PPROM. No significant increase in other adverse neonatal outcomes was seen among infants with meconium staining, suggesting a limited prognostic value of this finding.
探讨腹裂妊娠中胎粪污染与围产期及新生儿结局之间的关联。
对2008年至2013年在两个学术医疗中心出生的产前诊断为腹裂的婴儿进行回顾性分析。比较有和没有胎粪污染的分娩的新生儿结局。主要结局定义为以下任何一种：新生儿败血症、机械通气时间延长、肠闭锁或死亡。次要结局为早产、胎膜早破（PPROM）和住院时间延长。
纳入108例腹裂婴儿，其中56例（52%）在分娩时有胎粪污染。与没有胎粪污染的婴儿相比，有胎粪污染的婴儿分娩时孕周较低（36.3（±1.4）周对37.0（±1.2）周，p = 0.007），PPROM发生率较高（25%对8%，p = 0.03）。胎粪污染与主要复合结局或其任何组成部分均无显著关联。调整后，胎粪污染仍与<36周的早产[比值比OR = 4.0，95%置信区间（CI）：1.5 - 11.4]和PPROM（OR = 3.8，95%CI：1.2 - 14.5）显著相关。
在腹裂婴儿中，胎粪污染与早产和PPROM有关。在有胎粪污染的婴儿中未观察到其他不良新生儿结局有显著增加，表明这一发现的预后价值有限。
