Morsing Eva, Maršál Karel, Ley David
Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden.
Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund University, Lund, Sweden.
Neonatology. 2018;114(3):205-211. doi: 10.1159/000489039. Epub 2018 Jun 25.
Very preterm (VPT) delivery after severe preeclampsia (PE) has been associated with adverse perinatal outcome. It is unclear whether fetal exposure to PE per se modifies the prevalence of neonatal morbidities associated with VPT birth.
To evaluate neonatal morbidity in VPT infants exposed to maternal PE compared to morbidity in nonexposed VPT infants.
This retrospective study consisted of all inborn infants delivered before 30 gestational weeks admitted to a tertiary-level neonatal intensive care unit between 1998 and 2014: 195 infants exposed to maternal PE were compared to 957 infants without maternal PE (background group). Prevalence rates of neonatal morbidity, cerebral palsy (CP), and mortality at 2 years of age were obtained from patient records.
The PE group had a lower median (IQR) birth weight (795 [262] g) and a higher median gestational age (GA) (27 [3] weeks) at birth than the background group (890 [385] g and 26 [3] weeks, respectively; both p < 0.001). Exposure to maternal PE was associated with lower rates of severe intraventricular hemorrhage (IVH) (2 vs. 11%), retinopathy of prematurity requiring treatment (2 vs. 7%), mortality (9 vs. 15%), and CP (4 vs. 8%). Exposure to PE remained associated with a reduced prevalence of severe IVH (OR 0.17, 95% CI 0.05-0.57) after adjustment for GA, multiple birth, Apgar score, delivery mode, sex, and antenatal steroid treatment.
Fetal exposure to PE is associated with a decreased rate of severe IVH following VPT birth. Studies on underlying mechanisms may provide a basis for prevention of IVH in the VPT infant.
重度子痫前期（PE）后极早产（VPT）分娩与不良围产期结局相关。尚不清楚胎儿暴露于PE本身是否会改变与VPT出生相关的新生儿发病率。
评估暴露于母亲PE的VPT婴儿与未暴露的VPT婴儿的新生儿发病率。
这项回顾性研究纳入了1998年至2014年间入住三级新生儿重症监护病房的所有孕30周前出生的新生儿：将195例暴露于母亲PE的婴儿与957例未暴露于母亲PE的婴儿（背景组）进行比较。从患者记录中获取新生儿发病率、脑瘫（CP）和2岁时死亡率的患病率。
PE组出生时的中位（IQR）出生体重较低（795 [262] g），中位胎龄（GA）较高（27 [3]周），而背景组分别为890 [385] g和26 [3]周（均p < 0.001）。暴露于母亲PE与严重脑室内出血（IVH）发生率较低（2%对11%）、需要治疗的早产儿视网膜病变（2%对7%）、死亡率（9%对15%）和CP（4%对8%）相关。在对GA、多胎妊娠、阿氏评分、分娩方式、性别和产前类固醇治疗进行调整后，暴露于PE仍与严重IVH患病率降低相关（OR 0.17，95% CI 0.05 - 0.57）。
胎儿暴露于PE与VPT出生后严重IVH发生率降低相关。对潜在机制的研究可能为预防VPT婴儿的IVH提供依据。
