O'Shea T M, Klinepeter K L, Meis P J, Dillard R G
Department of Pediatrics, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157, USA.
Paediatr Perinat Epidemiol. 1998 Jan;12(1):72-83.
Very low-birthweight infants constitute more than one-quarter of all new cases of cerebral palsy. We performed a case-control study of associations between antenatal maternal infection and cerebral palsy in very low-birthweight infants. Cases and controls were selected from a cohort of 1238 consecutive infants who: (1) had birthweights between 500 and 1500 g and no major congenital anomaly; (2) were born 1 January 1986 to 31 December 1993 to a mother residing in 1 of 17 counties in north-west North Carolina; and (3) were delivered at the only tertiary obstetric referral centre in those same 17 counties. A total of 984 of these infants (79%) survived to 1 year of age (adjusted for degree of prematurity) and were scheduled for a multidisciplinary examination; 815 (83%) came as scheduled. Excluding two cases attributable to post-neonatal events, 62 cases of cerebral palsy were identified. Controls were the two infants, without cerebral palsy, born closest in time to each case. Medical records were reviewed by a nurse who was not aware of which subjects were cases. Among possible markers of intra-amniotic infection, those associated most strongly with cerebral palsy were chorioamnionitis diagnosed by an obstetrician (odds ratio [OR] adjusted for gestational age [95% confidence limits] = 2.6 [1.0, 6.5]), antepartum maternal temperature > 37.8 degrees C (OR = 2.6 [1.1, 6.0]), uterine tenderness (OR = 2.6 [0.8, 9.3]), maternal receipt of antibiotics (OR = 2.2 [1.0, 4.7]) and neonatal sepsis in the first week of life (OR = 2.9 [0.9, 8.9]). All of these associations were stronger for diplegia than the other clinical subtypes of cerebral palsy. The association with chorioamnionitis and spastic diplegia persisted when adjusted for maternal magnesium sulphate receipt, maternal betamethasone receipt, method of delivery (vaginal vs. abdominal), acidosis on the neonate's initial arterial blood gas, systolic blood pressure < 30 mmHg and the diagnosis of major neonatal neurosonographic abnormality.
极低体重儿占所有脑瘫新病例的四分之一以上。我们对极低体重儿产前母亲感染与脑瘫之间的关联进行了一项病例对照研究。病例和对照选自一组连续的1238名婴儿，这些婴儿：（1）出生体重在500至1500克之间且无重大先天性异常；（2）于1986年1月1日至1993年12月31日出生，母亲居住在北卡罗来纳州西北部17个县中的一个；（3）在这17个县唯一的三级产科转诊中心分娩。这些婴儿中共有984名（79%）存活至1岁（根据早产程度进行调整）并被安排进行多学科检查；815名（83%）按计划前来。排除两例归因于新生儿期后事件的病例后，共确定了62例脑瘫病例。对照是与每例病例出生时间最接近的两名无脑瘫婴儿。由一名不知道哪些受试者是病例的护士查阅病历。在羊膜腔内感染的可能标志物中，与脑瘫关联最密切的是产科医生诊断的绒毛膜羊膜炎（经胎龄调整的比值比[OR][95%置信区间]=2.6[1.0,6.5]）、产前母亲体温>37.8摄氏度（OR=2.6[1.1,6.0]）、子宫压痛（OR=2.6[0.8,9.3]）、母亲接受抗生素治疗（OR=2.2[1.0,4.7]）以及出生后第一周的新生儿败血症（OR=2.9[0.9,8.9]）。所有这些关联在双瘫型脑瘫中比在其他临床亚型的脑瘫中更强。在调整了母亲硫酸镁治疗、母亲倍他米松治疗、分娩方式（阴道分娩与剖宫产）、新生儿初始动脉血气中的酸中毒、收缩压<30 mmHg以及主要新生儿神经超声异常的诊断后，与绒毛膜羊膜炎和痉挛性双瘫的关联仍然存在。
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