Parodi Alessandro, De Angelis Laura Costanza, Re Martina, Raffa Sarah, Malova Mariya, Rossi Andrea, Severino Mariasavina, Tortora Domenico, Morana Giovanni, Calevo Maria Grazia, Brisigotti Maria Pia, Buffelli Francesca, Fulcheri Ezio, Ramenghi Luca Antonio
Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
Front Neurol. 2020 Aug 14;11:761. doi: 10.3389/fneur.2020.00761. eCollection 2020.
Placental pathology as a predisposing factor to intraventricular hemorrhage remains a matter of debate, and its contribution to cerebellar hemorrhage development is still largely unexplored. Our study aimed to assess placental and perinatal risk factors for intraventricular and cerebellar hemorrhages in preterm infants. This retrospective cohort study included very low-birth weight infants born at the Gaslini Children's Hospital between January 2012 and October 2016 who underwent brain magnetic resonance with susceptibility-weighted imaging at term-equivalent age and whose placenta was analyzed according to the Amsterdam Placental Workshop Group Consensus Statement. Of the 286 neonates included, 68 (23.8%) had intraventricular hemorrhage (all grades) and 48 (16.8%) had a cerebellar hemorrhage (all grades). After correction for gestational age, chorioamnionitis involving the maternal side of the placenta was found to be an independent risk factor for developing intraventricular hemorrhage, whereas there was no association between maternal and fetal inflammatory response and cerebellar hemorrhage. Among perinatal factors, we found that intraventricular hemorrhage was significantly associated with cerebellar hemorrhage (odds ratio [OR], 8.14), mechanical ventilation within the first 72 h (OR, 2.67), and patent ductus arteriosus requiring treatment (OR, 2.6), whereas cesarean section emerged as a protective factor (OR, 0.26). Inotropic support within 72 h after birth (OR, 5.24) and intraventricular hemorrhage (OR, 6.38) were independent risk factors for cerebellar hemorrhage, whereas higher gestational age was a protective factor (OR, 0.76). Assessing placental pathology may help in understanding mechanisms leading to intraventricular hemorrhage, although its possible role in predicting cerebellar bleeding needs further evaluation.
胎盘病理作为脑室内出血的一个诱发因素仍存在争议，其对小脑出血发展的影响在很大程度上仍未得到充分研究。我们的研究旨在评估早产儿脑室内出血和小脑出血的胎盘及围产期危险因素。这项回顾性队列研究纳入了2012年1月至2016年10月在加斯利尼儿童医院出生的极低出生体重儿，这些婴儿在足月等效年龄时接受了脑磁共振敏感性加权成像检查，并且其胎盘根据阿姆斯特丹胎盘研讨会小组共识声明进行了分析。在纳入的286例新生儿中，68例（23.8%）发生了脑室内出血（所有级别），48例（16.8%）发生了小脑出血（所有级别）。校正胎龄后，发现累及胎盘母体侧的绒毛膜羊膜炎是发生脑室内出血的独立危险因素，而母体和胎儿炎症反应与小脑出血之间没有关联。在围产期因素中，我们发现脑室内出血与小脑出血显著相关（优势比[OR]，8.14）、出生后72小时内机械通气（OR，2.67）以及需要治疗的动脉导管未闭（OR，2.6），而剖宫产是一个保护因素（OR，0.26）。出生后72小时内使用血管活性药物支持（OR，5.24）和脑室内出血（OR，6.38）是小脑出血的独立危险因素，而较高的胎龄是一个保护因素（OR，0.76）。评估胎盘病理可能有助于理解导致脑室内出血的机制，尽管其在预测小脑出血方面的可能作用需要进一步评估。
