Robertson C M, Finer N N
University of Alberta, Edmonton, Canada.
Clin Perinatol. 1993 Jun;20(2):483-500.
Available evidence shows adverse sequelae do not follow perinatal asphyxia unless encephalopathy is part of the neonatal clinical presentation. Where neonatal encephalopathy follows evidence of late fetal and/or early neonatal distress, the staging of the encephalopathy is useful for determination of prognosis; those with mild encephalopathy do well; those with severe encephalopathy do poorly. We believe this staging could be made more universally useful as an outcome variable for study of the etiology and timing of perinatal hypoxic-ischemic injury as well as for prediction of long-term outcome, if clinical correlates to pathophysiologic hypoxic-ischemic insults were used more broadly as the basis for defining the staging criteria. Most survivors of perinatal asphyxia do not have adverse sequelae, and later cognitive development has been shown to be similar to normative data. Although survivors of mild or severe encephalopathy have a predicted outcome, the outcome of those with moderate (Stage 2) hypoxic-ischemic encephalopathy is less certain; however, these children are at risk for neurologic disability and future academic failure. Prediction equations with good specificity for school-readiness outcome of the nondisabled survivors of moderate encephalopathy have been established allowing for early discharge from follow-up for those children predicted to do well. Mean school-age psychoeducational test results show nondisabled moderate encephalopathy survivors have scores below those in the mild encephalopathy group as well as below comparison groups, particularly for tests involving the auditory pathway, attention, and short-term recall; it is not known if these delays will resolve with time. School-aged nondisabled moderate encephalopathy survivors did not show the perceptual-motor delay reported in younger survivors. Overall, tests used to evaluate subtle changes that may relate to perinatal hypoxic-ischemic injury have been inadequate; future studies should include tests of acquisition of new learning, memory, problem solving, and reasoning. Further research is required to define the nature and timing of perinatal insults and the continued function of survivors.
现有证据表明，除非脑病是新生儿临床表现的一部分，否则围产期窒息不会导致不良后遗症。当新生儿脑病出现在胎儿晚期和/或早期新生儿窘迫的证据之后，脑病的分期有助于判断预后；轻度脑病患儿预后良好；重度脑病患儿预后较差。我们认为，如果将临床与病理生理缺氧缺血性损伤的相关性更广泛地用作定义分期标准的基础，那么这种分期对于围产期缺氧缺血性损伤的病因和时间研究以及长期预后预测而言，可能会变得更具普遍实用性。大多数围产期窒息幸存者没有不良后遗症，并且后来的认知发展已被证明与标准数据相似。尽管轻度或重度脑病幸存者有预期的预后，但中度（2期）缺氧缺血性脑病幸存者的预后较不确定；然而，这些儿童有神经功能残疾和未来学业失败的风险。已经建立了对中度脑病非残疾幸存者入学准备结果具有良好特异性的预测方程，这使得预计表现良好的儿童可以提前结束随访。学龄期心理教育测试结果的平均值显示，中度脑病非残疾幸存者的得分低于轻度脑病组以及对照组，特别是在涉及听觉通路、注意力和短期记忆的测试中；尚不清楚这些延迟是否会随着时间的推移而得到缓解。学龄期中度脑病非残疾幸存者没有表现出较年幼幸存者中报告的感知运动延迟。总体而言，用于评估可能与围产期缺氧缺血性损伤相关的细微变化的测试并不充分；未来的研究应包括对新学习、记忆、问题解决和推理能力获取的测试。需要进一步研究来确定围产期损伤的性质和时间以及幸存者的持续功能。
