Levy B T, Dawson J D, Toth P P, Bowdler N
Department of Family Medicine, University of Iowa, Iowa City 52242, USA.
Obstet Gynecol. 1998 Jun;91(6):909-16. doi: 10.1016/s0029-7844(98)00094-5.
To identify risk factors associated with poorer immediate neonatal outcomes among growth-restricted neonates.
Records of all 530 growth-restricted neonates born between January 1989 and February 1995 were reviewed. Outcomes included resuscitation measures, Apgar scores, and umbilical blood gas values. Neonates were assigned to one of six anesthetic groups, and outcomes were compared. Predictors of poorer outcomes were examined using logistic and linear regression.
Neonates exposed to general anesthesia were more likely to be intubated (37.9% versus 4.1%, P < .001, Pearson chi2) and had lower mean 1- (4.0 versus 7.0) and 5-minute (6.5 versus 8.4) Apgar scores (P < .01, Scheffé) than those in all other anesthetic groups. They also had significantly lower umbilical artery (UA) pH values than neonates who received nalbuphine, epidural, or no anesthesia (7.21 versus 7.28, 7.26, 7.29, respectively; P < .01, Scheffé). Factors that significantly and independently predicted intubation among all neonates included exposure to general anesthesia (odds ratio [OR] 4.1; 95% confidence interval [CI] 1.9, 8.9) and lower infant weight (OR 10.1 per kg decrease; CI 5.1, 20). Factors predicting UA pH at most 7.15 included preeclampsia (OR 3.0; CI 1.5, 5.9) and older maternal age (OR 1.3 per 5 years; CI 1.02, 1.64); vertex delivery (OR 0.5; CI 0.2, 0.9) was protective. Factors predicting a 5-minute Apgar less than 7 were meconium (OR 1.5 per category going from none to terminal to light to heavy; CI 1.04, 2.3), general anesthesia (OR 6.9; CI 2.6, 18.2), lower infant weight (OR 16.5 per kg decrease; CI 7.8, 34.5), and vaginal breech delivery (OR 7.0; CI 1.8, 28.6); cesarean delivery (OR 0.2; CI 0.08, 0.66) was protective. Spontaneous vertex delivery raised the UA pH, and preeclampsia, amnioinfusion, breech delivery, and general anesthesia significantly and independently lowered the UA pH among all neonates. For infants delivered by cesarean, "fetal distress," preeclampsia, previous spontaneous abortion, failed forceps use, and nalbuphine significantly and independently predicted lower UA pH.
Risk factors for poorer immediate neonatal outcomes among growth-restricted neonates include preeclampsia, fetal distress, breech delivery, forceps use, nalbuphine during labor, lower infant weight, and general anesthesia.
确定与生长受限新生儿较差的即刻新生儿结局相关的危险因素。
回顾了1989年1月至1995年2月期间出生的所有530例生长受限新生儿的记录。结局包括复苏措施、阿氏评分和脐血气值。将新生儿分为六个麻醉组之一，并比较结局。使用逻辑回归和线性回归检查较差结局的预测因素。
接受全身麻醉的新生儿比其他所有麻醉组的新生儿更有可能需要插管（37.9% 对4.1%，P <.001，Pearson卡方检验），且1分钟（4.0对7.0）和5分钟（6.5对8.4）的平均阿氏评分更低（P <.01，谢费检验）。他们的脐动脉（UA）pH值也显著低于接受纳布啡、硬膜外麻醉或未接受麻醉的新生儿（分别为7.21对7.28、7.26、7.29；P <.01，谢费检验）。在所有新生儿中，显著且独立预测插管的因素包括接受全身麻醉（优势比[OR]4.1；95%置信区间[CI]1.9，8.9）和较低的婴儿体重（每千克减少OR 10.1；CI 5.1，20）。预测UA pH值至多为7.15的因素包括先兆子痫（OR 3.0；CI 1.5，5.9）和较高的产妇年龄（每5岁OR 1.3；CI 1.02，1.64）；头位分娩（OR 0.5；CI 0.2，0.9）具有保护作用。预测5分钟阿氏评分低于7分的因素包括胎粪（从无到终末、轻度到重度每一级别OR 1.5；CI 1.04，2.3）、全身麻醉（OR 6.9；CI 2.6，18.2）、较低的婴儿体重（每千克减少OR 16.5；CI 7.8，34.5）和阴道臀位分娩（OR 7.0；CI 1.8，28.6）；剖宫产（OR 0.2；CI 0.08，0.66）具有保护作用。自然头位分娩可提高UA pH值，而先兆子痫、羊膜腔灌注、臀位分娩和全身麻醉在所有新生儿中显著且独立地降低了UA pH值。对于剖宫产分娩的婴儿，“胎儿窘迫”、先兆子痫、既往自然流产、产钳使用失败和纳布啡显著且独立地预测较低的UA pH值。
生长受限新生儿较差的即刻新生儿结局的危险因素包括先兆子痫、胎儿窘迫、臀位分娩、产钳使用、分娩期间使用纳布啡、较低的婴儿体重和全身麻醉。
