Perlman J M, Risser R C, Gee J B
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063, USA.
Pediatr Neurol. 1997 Jul;17(1):29-33. doi: 10.1016/s0887-8994(97)00073-8.
Increasing evidence suggests that the incidence of periventricular intraventricular hemorrhage (PV-IVH) is lower in infants born to mothers with pregnancy-induced hypertension (PIH). The mechanism or mechanisms accounting for this reduction remain unclear but may be related to PIH itself, medications used to treat the mother (e.g., magnesium sulfate), or to obstetrical management. In this retrospective analysis, we determined the incidence of PV-IVH in singleton preterm infants weighing less than 1,500 gm born to mothers with PIH who were also administered magnesium sulfate. Between January 1988 and December 1994, 254 singleton infants born to mothers with PIH and 1,083 born to mothers without PIH were studied. PV-IVH developed in 360 (26.9%) of the 1,337 infants; 977 (74.1%) infants did not exhibit PV-IVH. The incidence of total as well as severe PV-IVH was lower in infants born to mothers with PIH than in those without PIH [i.e., 16% vs 30% (total) and 8.2% vs 14.5% (severe), P < .001] with an odds ratio (OR) estimate of 0.43 [95% confidence interval (CI) 0.30, 0.61]. Infants born to mothers with PIH weighed more, (1,152 +/- 250 gm vs 1,058 +/- 283 gm, P < .001) and were more mature (30.1 +/- 2.9 vs 27.7 +/- 31 weeks, P < .001) than infants born to mothers without PIH. These infants were also less likely to be exposed to labor (57% vs 93%), to be delivered by cesarean section (81% vs 35%), and to require intubation (49% vs 58%), but more likely to exhibit respiratory distress syndrome (RDS) (47% vs 38%, P < .01). By logistic regression analysis, after seven variables (i.e., PIH, gestational age, and birthweight, both modeled as cubic polynomials; labor; intubation; RDS; and race) were included in the analytic model, PIH remained a significant predictor of IVH: P = .006, OR = 0.54 (95% CI 0.349, 0.847). These data indicate a significantly lower incidence of PV-IVH of approximately 50% in infants born to mothers with PIH as compared with the incidence in infants born to mothers without PIH, despite their higher incidence of RDS. The reduction in PV-IVH may be directly related to the PIH; however, the independent role of antenatal magnesium sulfate administration requires further study.
越来越多的证据表明，妊娠高血压综合征（PIH）母亲所生婴儿的脑室周围脑室内出血（PV-IVH）发生率较低。导致这种降低的一种或多种机制尚不清楚，但可能与PIH本身、用于治疗母亲的药物（如硫酸镁）或产科管理有关。在这项回顾性分析中，我们确定了体重小于1500克的单胎早产PIH母亲所生婴儿中PV-IVH的发生率，这些母亲也接受了硫酸镁治疗。在1988年1月至1994年12月期间，研究了254名单胎PIH母亲所生婴儿和1083名非PIH母亲所生婴儿。1337名婴儿中有360名（26.9%）发生了PV-IVH；977名（74.1%）婴儿未出现PV-IVH。PIH母亲所生婴儿的总体及重度PV-IVH发生率低于非PIH母亲所生婴儿[即分别为16%对30%（总体）和8.2%对14.5%（重度），P<0.001]，优势比（OR）估计为0.43[95%置信区间（CI）0.30，0.61]。PIH母亲所生婴儿比非PIH母亲所生婴儿体重更重（1152±250克对1058±283克，P<0.001）且更成熟（30.1±2.9周对27.7±3.1周，P<0.001）。这些婴儿也不太可能经历分娩（57%对93%）、剖宫产（81%对35%）和需要插管（49%对58%），但更可能出现呼吸窘迫综合征（RDS）（47%对38%，P<0.01）。通过逻辑回归分析，在将七个变量（即PIH、孕周、出生体重，均建模为三次多项式；分娩；插管；RDS；和种族）纳入分析模型后，PIH仍然是IVH的显著预测因素：P = 0.006，OR = 0.54（95%CI 0.349，0.847）。这些数据表明，与非PIH母亲所生婴儿相比，PIH母亲所生婴儿的PV-IVH发生率显著降低约50%，尽管他们的RDS发生率较高。PV-IVH的降低可能与PIH直接相关；然而，产前硫酸镁给药的独立作用需要进一步研究。
