Akindele R N, Audu L I, Mokuolu O A
Department of Pediatrics, National Hospital, Abuja, Nigeria.
Department of Pediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Nigeria.
Niger J Clin Pract. 2017 Mar;20(3):320-327. doi: 10.4103/1119-3077.196060.
Although research has shown that having a macrosomic fetus could be predictive of a negative pregnancy outcome, the factors that control its incidence and the outcome of delivery management have been less well characterized in Africa. The aim of this study was to identify specific predispositions and the factors that influence the early neonatal outcome of macrosomic infants in Abuja.
Data from 120 mother and macrosomic (weighing ≥4000 g) newborn pairs, and an equal number of mother and normal weight (2500-3999 g) matched controls, delivered over a 5-month period at three large hospitals in Abuja, Nigeria, were analyzed. Chi-square and logistic regression analyses were performed for various predisposing factors and neonatal outcomes of macrosomic births.
The incidence of macrosomia was 77 per 1000 births. Independent predictors of macrosomia were parental high social class (P = 0.000), gestational weight gain of ≥15 kg (P = 0.000), and previous history of macrosomia (P = 0.002). The most frequent route of delivery was emergency cesarean section accounting for 51 (42%) births. Macrosomia was significantly associated with higher rates of birth injuries (P = 0.030), perinatal asphyxia (P = 0.015), admissions into the special care newborn unit (P = 0.000), and hypoglycemia (P = 0.000). Although the difference in the early neonatal mortality rates between the macrosomic group (2.5%) and the control group (0.8%) was not statistically significant, nearly 70% of deaths in the macrosomic group were associated with severe perinatal asphyxia.
Our findings highlight the need for improved anticipatory care of the macrosomic fetus at delivery, in Africa.
尽管研究表明巨大胎儿可能预示着不良妊娠结局，但在非洲，控制其发生率及分娩管理结局的因素尚未得到充分描述。本研究的目的是确定阿布贾巨大儿的特定易患因素及其对早期新生儿结局的影响因素。
分析了尼日利亚阿布贾三家大型医院在5个月内分娩的120对母亲与巨大儿（体重≥4000克）新生儿的数据，以及同等数量的母亲与正常体重（2500 - 3999克）匹配对照的数据。对巨大儿出生的各种易患因素和新生儿结局进行了卡方检验和逻辑回归分析。
巨大儿的发生率为每1000例分娩中有77例。巨大儿的独立预测因素为父母社会阶层高（P = 0.000）、孕期体重增加≥15千克（P = 0.000）以及既往巨大儿史（P = 0.002）。最常见的分娩方式是急诊剖宫产，占51例（42%）。巨大儿与较高的出生损伤发生率（P = 0.030）、围产期窒息（P = 0.015）、入住新生儿特别护理病房（P = 0.000）以及低血糖（P = 0.000）显著相关。尽管巨大儿组（2.5%）和对照组（0.8%）的早期新生儿死亡率差异无统计学意义，但巨大儿组近70%的死亡与严重围产期窒息有关。
我们的研究结果强调了在非洲改善分娩时对巨大胎儿进行预期护理的必要性。
