Grether J K, Nelson K B, Emery E S, Cummins S K
California Birth Defects Monitoring Program, California Department of Health Services, Emeryville 94608-1811, USA.
J Pediatr. 1996 Mar;128(3):407-14. doi: 10.1016/s0022-3476(96)70292-5.
To identify prenatal and perinatal characteristics associated with cerebral palsy (CP) in infants born weighing < 1500 gm (very low birth weight, VLBW).
All 42 VLBW singleton infants with CP born in the period from 1983 to 1985 in a defined population were compared with 75 randomly selected VLBW control infants.
Birth in a level I facility was associated with increased risk of CP (odds ratio (OR) 6.3, 95% confidence interval (CI) 1.8, 19), as was birth within 3 hours of the mother's first admission for delivery (OR 3.2, CI 1.4, 7.4). Delivery occurred within 3 hours of admission to a level I facilty in 24% of VLBW children with CP and no control children (OR (0.5 added to each cell of 2 x 2 table) 49, CI 3.1, 204). Chorionitis was associated with increased risk in children born more than 5 hours after admission (OR 4.3, CI 1.1, 13). Chorionitis followed by neonatal seizures occurred in 14% of VLBW children with CP (in 25% with spastic diplegia) and in no control child (OR (0.5 added to each cell of 2 x 2 table) 26, CI 1.6, 116). Preeclampsia was associated with decreased risk (OR 0.08, CI 0.02, 0.67), as was use of magnesium sulfate (OR 0.14, CI 0.05, 0.51) administered for preeclampsia or preterm labor. Other risk factors for CP included gravidity greater than one (OR 3.9, CI 1.2, 11), short interbirth interval (OR 4.1, CI 1.3, 12), and vaginal bleeding on the day of admission (OR 2.9, CI 1.2, 7.4).
In this population-based study, almost one fourth of the CP in VLBW children occurred in infants delivered in level I facilities soon after their mothers' admissions. Another 14% was in children who had neonatal seizures after birth to women with chorionitis. No control subject experienced either of these sequences.
确定出生体重<1500克（极低出生体重，VLBW）婴儿中与脑瘫（CP）相关的产前和围产期特征。
将1983年至1985年期间在特定人群中出生的42例患有CP的VLBW单胎婴儿与75例随机选择的VLBW对照婴儿进行比较。
在一级医疗机构出生与CP风险增加相关（优势比（OR）6.3，95%置信区间（CI）1.8，19），母亲首次入院分娩后3小时内出生也与之相关（OR 3.2，CI 1.4，7.4）。24%的患有CP的VLBW儿童在入院一级医疗机构后3小时内分娩，而对照儿童中无此情况（OR（在2×2表的每个单元格中加0.5）49，CI 3.1，204）。绒毛膜羊膜炎与入院后5小时以上出生儿童的风险增加相关（OR 4.3，CI 1.1，13）。绒毛膜羊膜炎后出现新生儿惊厥的情况在14%的患有CP的VLBW儿童中出现（25%为痉挛性双瘫患儿），对照儿童中无此情况（OR（在2×2表的每个单元格中加0.5）26，CI 1.6，116）。先兆子痫与风险降低相关（OR 0.08，CI 0.02，0.67），用于先兆子痫或早产的硫酸镁使用也与之相关（OR 0.14，CI 0.05，0.51）。CP的其他风险因素包括妊娠次数大于1次（OR 3.9，CI 1.2，11）、产次间隔短（OR 4.1，CI 1.3，12）以及入院当天阴道出血（OR 2.9，CI 1.2，7.4）。
在这项基于人群的研究中，VLBW儿童中近四分之一的CP发生在其母亲入院后不久于一级医疗机构分娩的婴儿中。另外14%发生在患有绒毛膜羊膜炎的母亲所生的出生后出现新生儿惊厥的儿童中。对照对象均未经历这两种情况。
