Spinillo A, Ometto A, Bottino R, Piazzi G, Iasci A, Rondini G
Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico S. Matteo, Italy.
Eur J Obstet Gynecol Reprod Biol. 1995 May;60(1):13-9. doi: 10.1016/0028-2243(95)02052-7.
This study was designed to evaluate the effect of antenatal risk factors on the occurrence of germinal matrix hemorrhage or intraventricular hemorrhage in preterm infants.
Antenatal factors were evaluated in 302 infants delivered between 24 and 33 completed weeks gestation. Ultrasonographic screening of intracranial hemorrhage was carried out in all the infants. The association between risk factors and neonatal intracranial hemorrhage was evaluated with both univariate and multivariate models.
In stepwise logistic regression analysis, birthweight was a better predictor of neonatal germinal matrix hemorrhage than gestational age. Conversely, gestational age better predicted intraventricular hemorrhage than did birthweight. Risk factors for neonatal germinal matrix hemorrhage and intraventricular hemorrhage were dissimilar. A history of heavy (> 10 cigarettes/day) maternal smoking on admission increased the risk of germinal matrix hemorrhage three-fold (odds ratio = 3.35; 95% C.I. 1.24-9.07). Antenatal corticosteroid use reduced the risk of intraventricular hemorrhage by 76% (odds ratio = 0.24; 95% C.I. 0.09-0.61). Among patients with spontaneous preterm delivery or premature rupture of fetal membranes, the presence of labor was a significant effect modifier of the gestational-age associated risk of germinal matrix hemorrhage-intraventricular hemorrhage.
Risk factors for neonatal germinal matrix hemorrhage are different from those for intraventricular hemorrhage. Most antenatal factors, especially those affecting fetal maturity, could influence the progression rather than the onset of intracranial hemorrhage.
本研究旨在评估产前危险因素对早产儿生发基质出血或脑室内出血发生的影响。
对302例妊娠24至33周整周分娩的婴儿的产前因素进行评估。对所有婴儿进行颅内出血的超声筛查。采用单变量和多变量模型评估危险因素与新生儿颅内出血之间的关联。
在逐步逻辑回归分析中，出生体重比胎龄更能预测新生儿生发基质出血。相反，胎龄比出生体重更能预测脑室内出血。新生儿生发基质出血和脑室内出血的危险因素不同。入院时母亲大量吸烟（>10支/天）史使生发基质出血风险增加两倍（优势比=3.35；95%可信区间1.24-9.07）。产前使用皮质类固醇使脑室内出血风险降低76%（优势比=0.24；95%可信区间0.09-0.61）。在自然早产或胎膜早破的患者中，产程的存在是胎龄相关的生发基质出血-脑室内出血风险的显著效应修饰因素。
新生儿生发基质出血的危险因素与脑室内出血的危险因素不同。大多数产前因素，尤其是那些影响胎儿成熟度的因素，可能影响颅内出血的进展而非发病。
