González de Dios J, Moya M
Servicio de Pediatria, Hospital Universitario San Juan, Alicante.
Rev Neurol. 1996 Aug;24(132):969-76.
There have been several attempts to relate either perinatal asphyxia at birth or abnormal neurological findings after asphyxia in neonatal period (hypoxic-ischemic encephalopathy), to outcome.
To investigate, in full-term infants, the relation between perinatal asphyxia, hypoxic-ischemic encephalopathy and neurologic sequelae at follow-up, and to define the main neurologic sequelae (cerebral palsy, mental retardation, neonatal death). Material and method. Prospective epidemiologic study over perinatal asphyxia in term neonates born in Universitary Hospital San Juan (Alicante, Spain) between November 1991-February 1995. Perinatal asphyxia was graded as non severe (1-minute Apgar score < or = 6 and/or umbilical artery pH < 7.20, with abnormal fetal heart rate patterns and/or meconium-stained amniotic fluid, and the need for immediate neonatal resuscitation) and severe (1-minute Apgar score < or = 3 and umbilical artery pH < 7.10). Hypoxic-ischemic encephalopathy was graded as mild, moderate and severe based on classification of Levene and Sarnat & Sarnat. The abnormalities on psicomotor development are based in the neurologic 'alert signs' and in the neurologic sequelae; this sequelae was graded as mild, moderate and severe based on classification of Finer and Amiel-Tison. The relationships between these variables are studied by univariant and multivariant analysis (Cox's regression).
The incidence of neurologic sequelae, in 115 asphyxiated full-term infants follow-up at least 12-24 months, was 16.5%; 4 cases of severe sequelae, 4 moderate and 11 mild. The overall asphyxia-related infant mortality rate was 0.87/1.000 live births. The main sequelae detected at follow-up was motor disability, and other disabilities like mental retardation, epilepsy, sensorial defects, were infrequents. The incidence of cerebral palsy was 0.87/1.000 live births, and 2.6% asphyctic term neonates. We found a statistically significant (p < 0.001) association between severity of perinatal asphyxia and/or evidence of hypoxic-ischemic-encephalopathy and the neurological development at follow-up. Of the several factors associated to risk of neurologic sequelae on univariant analysis, only two were independently associated on multivariant analysis: severe perinatal asphyxia (RR = 2.82; IC = 1.07-7.39) and postasphyctic encephalopathy (RR = 4.17; IC = 1.48-11.75).
Most survivors of perinatal asphyxia do not have adverse sequelae. The best predictive tool for the neurological prognosis at follow-up was severe perinatal asphyxia at birth and evidence of encephalopathy in neonatal period. Our study confirm that perinatal asphyxia is infrequently the cause of cerebral palsy and mental retardation.
已有多项研究试图将出生时的围产期窒息或新生儿期窒息后出现的异常神经学表现（缺氧缺血性脑病）与预后联系起来。
研究足月儿围产期窒息、缺氧缺血性脑病与随访时神经后遗症之间的关系，并确定主要的神经后遗症（脑瘫、智力发育迟缓、新生儿死亡）。材料与方法。对1991年11月至1995年2月在西班牙阿利坎特圣胡安大学医院出生的足月新生儿围产期窒息进行前瞻性流行病学研究。围产期窒息分为非重度（1分钟阿氏评分≤6分和/或脐动脉pH值<7.20，伴有异常胎儿心率模式和/或羊水胎粪污染，且需要立即进行新生儿复苏）和重度（1分钟阿氏评分≤3分且脐动脉pH值<7.10）。根据Levene和Sarnat & Sarnat的分类，将缺氧缺血性脑病分为轻度、中度和重度。精神运动发育异常基于神经学“警觉体征”和神经后遗症；根据Finer和Amiel-Tison的分类，将该后遗症分为轻度、中度和重度。通过单变量和多变量分析（Cox回归）研究这些变量之间的关系。
在115例窒息足月儿中，至少随访12 - 24个月，神经后遗症的发生率为16.5%；4例为严重后遗症，4例为中度，11例为轻度。与窒息相关的婴儿总体死亡率为0.87/1000活产。随访时检测到的主要后遗症是运动障碍，而智力发育迟缓、癫痫、感觉缺陷等其他障碍较少见。脑瘫的发生率为0.87/1000活产，窒息足月儿中为2.6%。我们发现围产期窒息的严重程度和/或缺氧缺血性脑病的证据与随访时的神经发育之间存在统计学显著关联（p<0.001）。在单变量分析中与神经后遗症风险相关的几个因素中，多变量分析中只有两个因素独立相关：重度围产期窒息（RR = 2.82；IC = 1.07 - 7.39）和窒息后脑病（RR = 4.17；IC = 1.48 - 11.75）。
大多数围产期窒息幸存者没有不良后遗症。随访时神经预后的最佳预测工具是出生时的重度围产期窒息和新生儿期脑病的证据。我们的研究证实围产期窒息很少是脑瘫和智力发育迟缓的原因。
