Hansen A R, Allred E N, Leviton A
Joint Program in Neonatology, Children's Hospital, Boston, MA 02115, USA.
J Child Neurol. 1997 Sep;12(6):381-6. doi: 10.1177/088307389701200608.
We aimed to identify medical care practices that influence the need for ventriculoperitoneal shunt among infants who develop intraventricular hemorrhage. We reviewed the medical records of 82 babies with ultrasonographically documented intraventricular hemorrhage. We compared the 10 babies who required a ventriculoperitoneal shunt to the 72 controls who had intraventricular hemorrhage, but did not require a ventriculoperitoneal shunt or die, prior to discharge. We considered maternal, perinatal, and neonatal risk factors as potential predictive variables. Maternal preeclampsia, prenatal steroids, and cesarean delivery were associated with a reduced risk of shunt. Patients who did require a shunt were more likely than their nonshunted peers to be treated with dopamine, to receive greater volumes of total intravenous fluid, largely as albumin and red blood cells, and to have a higher incidence of acidosis, patent ductus arteriosus and systolic hypertension. Previously identified antecedents and correlates of intraventricular hemorrhage appear also to be the antecedents and correlates of progression to ventriculoperitoneal shunt among infants with intraventricular hemorrhage. These findings are consistent with the possibility that prenatal and postnatal care practices influence the risk for ventriculoperitoneal shunt among babies with intraventricular hemorrhage. This offers the promise that changes in obstetric and neonatal care will reduce the need for ventriculoperitoneal shunt in very low birthweight infants.
我们旨在确定影响发生脑室内出血的婴儿行脑室腹腔分流术需求的医疗护理措施。我们回顾了82例经超声检查证实有脑室内出血的婴儿的病历。我们将10例需要行脑室腹腔分流术的婴儿与72例在出院前有脑室内出血但不需要行脑室腹腔分流术或未死亡的对照婴儿进行了比较。我们将母亲、围产期和新生儿危险因素视为潜在的预测变量。母亲先兆子痫、产前使用类固醇和剖宫产与分流风险降低相关。需要分流的患者比未分流的同龄人更有可能接受多巴胺治疗，接受更大体积的总静脉液体（主要是白蛋白和红细胞），并且酸中毒、动脉导管未闭和收缩期高血压的发生率更高。先前确定的脑室内出血的前驱因素和相关因素似乎也是脑室内出血婴儿进展至脑室腹腔分流术的前驱因素和相关因素。这些发现与产前和产后护理措施影响脑室内出血婴儿脑室腹腔分流术风险的可能性一致。这为产科和新生儿护理的改变将减少极低出生体重儿脑室腹腔分流术的需求带来了希望。
