因胎心监护不典型行剖宫产分娩与子代儿科感染性疾病相关住院风险的研究
Intrapartum Cesarean Delivery Due to Nonreassuring Fetal Heart Rate and the Risk of Pediatric Infectious Morbidity-related Hospitalizations of the Offspring.
机构信息
From the Department of Obstetrics and Gynecology, Soroka University Medical Center, and.
The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
出版信息
Pediatr Infect Dis J. 2021 Jul 1;40(7):669-673. doi: 10.1097/INF.0000000000003100.
OBJECTIVES
One of the most common indications for intrapartum cesarean delivery (CD) is nonreassuring fetal heart rate (NRFHR) patterns. We aimed to study the long-term effect of CD due to NRFHR on the risk for subsequent childhood infectious morbidity-related hospitalizations of the offspring.
STUDY DESIGN
A population-based cohort study was performed, comparing total and different subtypes of infectious morbidity-related pediatric hospitalizations among offspring born by CD due to NRFHR versus labor dystocia (failure of labor to progress during the 1st or 2nd stage). The analysis included all singletons born between the years 1999-2014 at a single tertiary regional medical center. Infectious-related morbidities included hospitalizations involving a predefined set of International Classification of Diseases, 9th revision codes, as recorded in hospital computerized files. Infants with congenital malformations, multiple gestations, vaginal deliveries and vacuum failure were excluded from the analysis. Perinatal mortality cases were excluded from the long-term analysis. A Kaplan-Meier survival curve was used to compare the cumulative morbidity, and a Cox proportional hazards model was constructed to adjust for confounders.
RESULTS
The study population included 9956 newborns who met inclusion criteria; among them, 5810 (58%) were born by CD due to NRFHR, and 4146 (42%) were born via CD following labor dystocia with normal fetal heart rate (comparison group). Offspring born following NRFHR had higher rates of infectious morbidity-related hospitalizations (11.4% vs. 9.1%; odds ratio, 1.3; 95% confidence interval, 1.1-1.5; P < 0.01; Kaplan-Meier survival curve P < 0.01). The association remained significant and independent while adjusting for gestational age, maternal age and comorbidities, using a Cox proportional hazards model (adjusted hazard ratio, 1.3; 95% confidence interval, 1.2-1.4; P < 0.01).
CONCLUSIONS
In our population, CD due to NRFHR is a risk factor for pediatric infectious morbidity-related hospitalizations of the offspring.
目的
产时剖宫产（CD）最常见的适应证之一是胎心监护（NRFHR）结果不理想。本研究旨在探讨因胎心监护结果不理想而行 CD 对后代随后发生与感染相关的儿科住院发病率的长期影响。
研究设计
本研究采用基于人群的队列研究，比较了因胎心监护结果不理想而行 CD 分娩与因产程进展不良（第 1 或第 2 产程进展缓慢）而行 CD 分娩的新生儿在总发病率和不同类型的与感染相关的儿科住院发病率方面的差异。该分析纳入了 1999 年至 2014 年期间在一家三级区域性医疗中心单胎分娩的所有新生儿。感染相关的发病率包括因预设的国际疾病分类，第 9 版代码而住院的患儿，这些数据记录在医院的计算机档案中。患有先天性畸形、多胎妊娠、阴道分娩和真空失败的婴儿被排除在分析之外。围产儿死亡病例被排除在长期分析之外。使用 Kaplan-Meier 生存曲线比较累积发病率，使用 Cox 比例风险模型调整混杂因素。
结果
本研究共纳入 9956 名符合纳入标准的新生儿；其中，5810 名（58%）因胎心监护结果不理想而行 CD 分娩，4146 名（42%）因胎心监护正常而行 CD 分娩（对照组）。因胎心监护结果不理想而行 CD 分娩的新生儿与感染相关的住院发病率更高（11.4% vs. 9.1%；比值比，1.3；95%置信区间，1.1-1.5；P < 0.01； Kaplan-Meier 生存曲线 P < 0.01）。使用 Cox 比例风险模型调整胎龄、母亲年龄和合并症等混杂因素后，该相关性仍然显著且独立（校正后的危险比，1.3；95%置信区间，1.2-1.4；P < 0.01）。
结论
在我们的人群中，因胎心监护结果不理想而行 CD 是后代发生与感染相关的儿科住院发病率的危险因素。
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