Klinger Gil, Bromiker Reuben, Zaslavsky-Paltiel Inna, Sokolover Nir, Lerner-Geva Liat, Yogev Yariv, Reichman Brian
Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Perinatol. 2021 Sep;38(11):1134-1141. doi: 10.1055/s-0040-1710353. Epub 2020 May 23.
We aimed to determine the independent effect of maternal antepartum hemorrhage (APH) on mortality and major neonatal morbidities among very low birth weight (VLBW), very preterm infants.
A population-based cohort study of VLBW singleton infants born at 24 to 31 weeks of gestation between 1995 and 2016 was performed. Infants born with the following pregnancy associated complications were excluded: maternal hypertensive disorders, prolonged rupture of membranes, amnionitis, maternal diabetes, and small for gestational age. APH included hemorrhage due to either placenta previa or placental abruption. Univariate and multivariable logistic regression analyses were performed to assess the effect of maternal APH on mortality and major neonatal morbidities.
The initial cohort included 33,627 VLBW infants. Following exclusions, the final study population comprised 6,235 infants of whom 2,006 (32.2%) were born following APH and 4,229 (67.8%) without APH. In the APH versus no APH group, there were higher rates of extreme prematurity (24-27 weeks of gestation; 51.6% vs. 45.3%, < 0.0001), mortality (20.2 vs. 18.5%, = 0.011), bronchopulmonary dysplasia (BPD, 16.1 vs. 13.0%, = 0.004) and death or adverse neurologic outcome (37.4 vs. 34.5%, = 0.03). In the multivariable analyses, APH was associated with significantly increased odds ratio (OR) for BPD in the extremely preterm infants (OR: 1.31, 95% confidence interval: 1.05-1.65). The OR's for mortality, adverse neurological outcomes, and death or adverse neurological outcome were not significantly increased in the APH group.
Among singleton, very preterm VLBW infants, maternal APH was associated with increased odds for BPD only in extremely premature infants, but was not associated with excess mortality or adverse neonatal neurological outcomes.
· Outcome of very low birth weight infants born after antepartum hemorrhage (APH) was assessed.. · APH was not associated with higher infant mortality.. · APH was not associated with adverse neurological outcome.. · APH was associated with increased bronchopulmonary dysplasia in extremely preterm infants..
我们旨在确定母亲产前出血（APH）对极低出生体重（VLBW）、极早产儿的死亡率和主要新生儿发病率的独立影响。
对1995年至2016年期间孕24至31周出生的VLBW单胎婴儿进行基于人群的队列研究。排除患有以下妊娠相关并发症的婴儿：母亲高血压疾病、胎膜早破、羊膜炎、母亲糖尿病和小于胎龄儿。APH包括前置胎盘或胎盘早剥引起的出血。进行单变量和多变量逻辑回归分析，以评估母亲APH对死亡率和主要新生儿发病率的影响。
初始队列包括33627名VLBW婴儿。排除后，最终研究人群包括6235名婴儿，其中2006名（32.2%）在APH后出生，4229名（67.8%）在无APH情况下出生。在APH组与无APH组中，极早产（孕24至27周；51.6%对45.3%，<0.0001）、死亡率（20.2%对18.5%，=0.011）、支气管肺发育不良（BPD，16.1%对13.0%，=0.004）以及死亡或不良神经结局（37.4%对34.5%，=0.03）的发生率更高。在多变量分析中，APH与极早产儿BPD的比值比（OR）显著增加相关（OR：1.31，95%置信区间：1.05 - 1.65）。APH组中死亡率、不良神经结局以及死亡或不良神经结局的OR未显著增加。
在单胎、极早产VLBW婴儿中，母亲APH仅与极早产儿BPD的几率增加相关，但与额外死亡率或不良新生儿神经结局无关。
·评估了产前出血（APH）后出生的极低出生体重婴儿的结局。·APH与较高的婴儿死亡率无关。·APH与不良神经结局无关。·APH与极早产儿支气管肺发育不良增加相关。
