Murphy D J, Sellers S, MacKenzie I Z, Yudkin P L, Johnson A M
National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford UK.
Lancet. 1995 Dec 2;346(8988):1449-54. doi: 10.1016/s0140-6736(95)92471-x.
The increase in survival of very preterm babies during the 1980s was accompanied by a sharp increase in the rate of cerebral palsy in this group. The relation between antenatal and intrapartum factors and cerebral palsy in such babies has not been well defined. To identify adverse and protective antenatal and intrapartum factors we undertook a case-control study of 59 very preterm babies who developed cerebral palsy, identified from a population-based register, and 234 randomly selected controls. The frequency of cerebral palsy decreased with increasing gestational age and birthweight. Antenatal complications occurred in 215 (73%) of the women with preterm deliveries. Factors associated with an increased risk of cerebral palsy after adjustment for gestational age were chorioamnionitis (odds ratio 4.2 [95% CI 1.4-12.0]) prolonged rupture of membranes (2.3 [1.2-4.2]), and maternal infection (2.3 [1.2-4..5]). Pre-eclampsia was associated with a reduced risk of cerebral palsy (0.4 [0.2-0.9]), as was delivery without labour (0.3 [0.2-0.7]). There was no increased risk of cerebral palsy with intrauterine growth retardation (1.0 [0.9-1.1]). The effect of rigorous management of adverse antenatal factors on the frequency of cerebral palsy in very preterm babies should be tested in randomised controlled trials.
20世纪80年代，极早产儿存活率的提高伴随着该群体脑瘫发病率的急剧上升。此类婴儿产前和产时因素与脑瘫之间的关系尚未明确界定。为了确定不良和保护性的产前及产时因素，我们进行了一项病例对照研究，研究对象为59例患脑瘫的极早产儿（从基于人群的登记册中确定）和234例随机选取的对照。脑瘫发生率随胎龄和出生体重增加而降低。215名（73%）早产女性出现了产前并发症。在对胎龄进行调整后，与脑瘫风险增加相关的因素包括绒毛膜羊膜炎（比值比4.2 [95%可信区间1.4 - 12.0]）、胎膜早破时间延长（2.3 [1.2 - 4.2]）以及母体感染（2.3 [1.2 - 4.5]）。子痫前期与脑瘫风险降低相关（0.4 [0.2 - 0.9]），未临产分娩也与之相关（0.3 [0.2 - 0.7]）。胎儿宫内生长受限并未增加脑瘫风险（1.0 [0.9 - 1.1]）。应通过随机对照试验来检验对不良产前因素进行严格管理对极早产儿脑瘫发生率的影响。
