Chevallier Marie, Debillon Thierry, Pierrat Veronique, Delorme Pierre, Kayem Gilles, Durox Mélanie, Goffinet François, Marret Stephane, Ancel Pierre Yves
Grenoble Alps University, Centre national de la recherche scientifique, TIMC-IMAG, Unite mixte de recherche 5525 ThEMAS, and Neonatal Intensive Care Unit, Grenoble University Hospital, Grenoble, France.
Grenoble Alps University, Centre national de la recherche scientifique, TIMC-IMAG, Unite mixte de recherche 5525 ThEMAS, and Neonatal Intensive Care Unit, Grenoble University Hospital, Grenoble, France.
Am J Obstet Gynecol. 2017 May;216(5):518.e1-518.e12. doi: 10.1016/j.ajog.2017.01.002. Epub 2017 Jan 16.
Intraventricular hemorrhage is a major risk factor for neurodevelopmental disabilities in preterm infants. However, few studies have investigated how pregnancy complications responsible for preterm delivery are related to intraventricular hemorrhage.
We sought to investigate the association between the main causes of preterm delivery and intraventricular hemorrhage in very preterm infants born in France during 2011 between 22-31 weeks of gestation.
The study included 3495 preterm infants from the national EPIPAGE 2 cohort study who were admitted to neonatal intensive care units and had at least 1 cranial ultrasound assessment. The primary outcome was grade I-IV intraventricular hemorrhage according to the Papile classification. Multinomial logistic regression models were used to study the relationship between risk of intraventricular hemorrhage and the leading causes of preterm delivery: vascular placental diseases, isolated intrauterine growth retardation, placental abruption, preterm labor, and premature rupture of membranes, with or without associated maternal inflammatory syndrome.
The overall frequency of grade IV, III, II, and I intraventricular hemorrhage was 3.8% (95% confidence interval, 3.2-4.5), 3.3% (95% confidence interval, 2.7-3.9), 12.1% (95% confidence interval, 11.0-13.3), and 17.0% (95% confidence interval, 15.7-18.4), respectively. After adjustment for gestational age, antenatal magnesium sulfate therapy, level of care in the maternity unit, antenatal corticosteroids, and chest compressions, infants born after placental abruption had a higher risk of grade IV and III intraventricular hemorrhage compared to those born under placental vascular disease conditions, with adjusted odds ratios of 4.3 (95% confidence interval, 1.1-17.0) and 4.4 (95% confidence interval, 1.1-17.6), respectively. Similarly, preterm labor with concurrent inflammatory syndrome was associated with an increased risk of grade IV intraventricular hemorrhage (adjusted odds ratio, 3.4; 95% confidence interval, 1.1-10.2]). Premature rupture of membranes did not significantly increase the risk.
Relationships between the causes of preterm birth and intraventricular hemorrhage were limited to specific and rare cases involving acute hypoxia-ischemia and/or inflammation. While the emergent nature of placental abruption would challenge any attempts to optimize management, the prenatal care offered during preterm labor could be improved.
脑室内出血是早产儿神经发育障碍的主要危险因素。然而，很少有研究调查导致早产的妊娠并发症与脑室内出血之间的关系。
我们试图研究2011年在法国出生的孕22 - 31周的极早产儿中，早产的主要原因与脑室内出血之间的关联。
该研究纳入了来自全国EPIPAGE 2队列研究的3495名早产儿，这些婴儿被收治入新生儿重症监护病房且至少接受过1次头颅超声评估。主要结局是根据Papile分类法的I - IV级脑室内出血。采用多项逻辑回归模型研究脑室内出血风险与早产的主要原因之间的关系：血管性胎盘疾病、孤立性子宫内生长受限、胎盘早剥、早产和胎膜早破，有无相关的母体炎症综合征。
IV级、III级、II级和I级脑室内出血的总体发生率分别为3.8%（95%置信区间，3.2 - 4.5）、3.3%（95%置信区间，2.7 - 3.9）、12.1%（95%置信区间，11.0 - 13.3）和17.0%（95%置信区间，15.7 - 18.4）。在调整了胎龄、产前硫酸镁治疗、产科护理水平、产前糖皮质激素和胸外按压后，与胎盘血管疾病情况下出生的婴儿相比，胎盘早剥后出生的婴儿发生IV级和III级脑室内出血的风险更高，调整后的优势比分别为4.3（95%置信区间，1.1 - 17.0）和4.4（95%置信区间，1.1 - 17.6）。同样，伴有炎症综合征的早产与IV级脑室内出血风险增加相关（调整后的优势比为3.4；95%置信区间，1.1 - 10.2）。胎膜早破并未显著增加风险。
早产原因与脑室内出血之间的关系仅限于涉及急性缺氧缺血和/或炎症的特定且罕见情况。虽然胎盘早剥的紧急性质会对任何优化管理的尝试构成挑战，但早产期间提供的产前护理可以得到改善。
