Helwich Ewa, Rutkowska Magdalena, Bokiniec Renata, Gulczyńska Ewa, Hożejowski Roman
Klinika Neonatologii, Instytutu Matki i Dziecka, Warszawa, Polska.
Klinika Neonatologii, Warszawski Uniwersytet Medyczny, Polska.
Dev Period Med. 2017;21(4):328-335. doi: 10.34763/devperiodmed.20172104.328335.
Intraventricular hemorrhage (IVH) is a common pathology in preterm infants with extremely and very low birth weight. It is particularly often seen in newborns with Respiratory Distress Syndrome (RDS).
To assess the incidence of IVH in preterm newborns with RDS treated with surfactant, and to identify factors that might reduce the risk of IVH in this population.
This multicenter, prospective cohort study is part of the "Neo-pro" study project. The investigations were carried out in 936 newborns, including 652 survivors. We enrolled a consecutive sample of infants born before 32 weeks' gestation. IVH was diagnosed with trans-fontanel ultrasonography, performed according to the approved standards and classified according to Papile's grading system.
Intraventricular hemorrhage was diagnosed in 462/936 infants (49.4%), and in 43.3% of the survivors. Grade 3 and 4 IVH occurred in 14.8% and 13.8% of the infants, respectively, and in 10.6% and 5.7% of the survivors. Lack of antenatal application in mothers of corticosteroids increased the incidence rate of severe IVH from 14.2% to 22.1% (p=0.0087). The risk of IVH was reduced with early (from the first day of life) initiation of caffeine citrate (OR: 0.63, 95% CI: 0.45-0.88), delivery by cesarean section (OR: 0.50, 95% CI: 0.36-0.69), and the risk of severe IVH - from treatment with antenatal corticosteroids (OR: 0.58, 95% CI: 0.39-0.87). The most significant factor which increased the risk of hemorrhage was invasive mechanical ventilation (OR: 2.90, 95% CI: 2.07-4.07). The risk was further increased if the duration of mechanical ventilation was greater than seven days (OR: 3.02, 95% CI: 2.21-4.12).
The incidence of IVH in newborns with RDS is significant and the risk of IVH is increased by mechanical ventilation. Antenatal exposure to corticosteroids and delivery by cesarean section have a protective effect, and the former also reduces the risk of the most severe manifestations of IVH. Caffeine citrate initiated from the first day of life is another protective strategy.
脑室内出血（IVH）是极低出生体重和超低出生体重早产儿的常见病理情况。在患有呼吸窘迫综合征（RDS）的新生儿中尤为常见。
评估接受表面活性剂治疗的RDS早产儿IVH的发生率，并确定可能降低该人群IVH风险的因素。
这项多中心前瞻性队列研究是“Neo-pro”研究项目的一部分。对936名新生儿进行了调查，其中包括652名幸存者。我们纳入了孕周小于32周的连续出生的婴儿样本。根据批准的标准通过经囟门超声检查诊断IVH，并根据Papile分级系统进行分类。
936名婴儿中有462名（49.4%）被诊断为脑室内出血，幸存者中的发生率为43.3%。3级和4级IVH分别发生在14.8%和13.8%的婴儿中，以及10.6%和5.7%的幸存者中。母亲产前未应用皮质类固醇使严重IVH的发生率从14.2%增加到22.1%（p = 0.0087）。从出生第一天开始早期使用枸橼酸咖啡因可降低IVH风险（OR：0.63，95% CI：0.45 - 0.88），剖宫产分娩可降低风险（OR：0.50，95% CI：0.36 - 0.69），产前皮质类固醇治疗可降低严重IVH的风险（OR：0.58，95% CI：0.39 - 0.87）。增加出血风险最显著的因素是有创机械通气（OR：2.90，95% CI：2.07 - 4.07）。如果机械通气时间超过7天，风险会进一步增加（OR：3.02，95% CI：2.21 - 4.12）。
RDS新生儿中IVH的发生率很高，机械通气会增加IVH风险。产前接触皮质类固醇和剖宫产分娩具有保护作用，前者还可降低IVH最严重表现的风险。从出生第一天开始使用枸橼酸咖啡因是另一种保护策略。
