组织学绒毛膜羊膜炎、产前类固醇与极低出生体重儿的新生儿结局：一项全国性研究。
Histological chorioamnionitis, antenatal steroids, and neonatal outcomes in very low birth weight infants: A nationwide study.
机构信息
Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
出版信息
PLoS One. 2019 Oct 29;14(10):e0224450. doi: 10.1371/journal.pone.0224450. eCollection 2019.
BACKGROUND
The aim of this study was to investigate whether some associations between histological chorioamnionitis (HCA) and favorable neonatal outcomes might be linked to those of antenatal steroids (AS) by determining the separate as well as the combined associations of HCA and AS with neonatal outcomes in very low birth weight infants (VLBWIs).
METHODS
This was a population-based study of VLBWIs born at 20-33 weeks' gestation between January 2013 and December 2015 from the Korean Neonatal Network. A total of 4652 VLBWIs were enrolled for prevalence study. Of these, 2900 singleton VLBWIs were used for outcome analyses to evaluate individual associations of HCA and AS simultaneously with correction for potential perinatal factors and an interaction term of HCA and AS.
RESULTS
The overall prevalence of HCA was 34.9% (1623 VLBWIs). Multivariable logistic regression demonstrated that HCA was associated with decreased mortality (adjusted odds ratio [aOR], 0.51; 95% confidence interval [CI], 0.29-0.91; P = 0.022), AS were associated with reduction in mortality (aOR, 0.59; 95% CI, 0.39-0.90; P = 0.014) and neonatal seizure (aOR, 0.57; 95% CI, 0.37-0.86; P = 0.008), and a combination of HCA and AS was associated with remarkably lowered severe intraventricular hemorrhage by interacting with each other (aOR, 0.47; 95% CI, 0.25-0.88; P = 0.019).
CONCLUSIONS
We suggest that in VLBWIs HCA and AS may be favorable independent factors for neonatal outcome and may also work in synergy for neuroprotection.
背景
本研究旨在通过确定组织学绒毛膜羊膜炎（HCA）与产前类固醇（AS）之间的某些关联是否与新生儿结局相关，来探讨 HCA 与良好新生儿结局之间的关系。方法：这是一项基于人群的研究，纳入了 2013 年 1 月至 2015 年 12 月期间在韩国新生儿网络中出生的胎龄为 20-33 周的极低出生体重儿（VLBWI）。共有 4652 例 VLBWI 纳入患病率研究。其中，2900 例单胎 VLBWI 用于结局分析，以评估 HCA 和 AS 与潜在围产期因素的个体关联，并校正 HCA 和 AS 的交互项。结果：HCA 的总患病率为 34.9%（1623 例 VLBWI）。多变量逻辑回归表明，HCA 与死亡率降低相关（调整优势比[aOR]，0.51；95%置信区间[CI]，0.29-0.91；P=0.022），AS 与死亡率降低（aOR，0.59；95%CI，0.39-0.90；P=0.014）和新生儿癫痫（aOR，0.57；95%CI，0.37-0.86；P=0.008）相关，HCA 和 AS 的组合通过相互作用与显著降低严重的脑室出血相关（aOR，0.47；95%CI，0.25-0.88；P=0.019）。结论：我们认为，在 VLBWI 中，HCA 和 AS 可能是新生儿结局的有利独立因素，并且可能在神经保护方面也具有协同作用。
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