Spinillo A, Capuzzo E, Stronati M, Ometto A, De Santolo A, Acciano S
Department of Obstetrics and Gynaecology, IRCCS Policlinico San Matteo, Pavia, Italy.
Br J Obstet Gynaecol. 1998 Aug;105(8):865-71. doi: 10.1111/j.1471-0528.1998.tb10231.x.
To evaluate the obstetric antecedents of cystic periventricular leukomalacia and transient echodense periventricular lesions among preterm infants.
A cohort study of preterm singleton infants born between 25 and 33 weeks gestation.
Pavia, Italy.
Three hundred and forty-nine infants admitted to a Division of Neonatal Intensive Care who were screened for periventricular leukomalacia.
The obstetric factors in infants with either cystic periventricular leukomalacia or transient echodense periventricular lesions were compared to those in infants with negative cranial ultrasonographic findings. Stepwise multiple logistic regression analysis was used to evaluate the association between risk factors and outcomes adjusting for confounders.
The prevalence of cystic periventricular leukomalacia and transient echodense lesions was 5.7% (20/349) and 14% (49/349), respectively. The main risk factors for cystic leukomalacia were first trimester haemorrhage (OR 4.49; 95% CI 1.63-12.39), maternal urinary tract infection on admission (OR 5.71; 95% CI 1.91-17.07), and neonatal acidosis (pH < 7.2) at birth (OR 5.97; 95% CI 1.93-18.52). Meconium-stained amniotic fluid (OR 3.95; 95% CI 1.42-10.98) and long term (> 72 hours) ritodrine tocolysis (OR 2.54; 95% CI 1.28-5.05) were associated with an increased risk of echodense lesions. The likelihood of overall leukomalacia (cystic plus echodense periventricular lesions) was increased among cases with meconium-stained amniotic fluid (OR 4.06; 95% CI 1.65-10.0), long-term ritodrine tocolysis (OR 2.56; 95% CI 1.38-4.72), maternal infection (OR 1.73; 95% CI 1.0-3.0), and acidosis at birth (OR 1.98; 95% CI 1.0-3.98).
This study confirms that maternal infection, acidosis at birth, and meconium-stained amniotic fluid increase the risk of periventricular leukomalacia in preterm infants. Long-term ritodrine use seems to increase the risk for transient echodense lesions.
评估早产儿脑室周围白质软化症和脑室周围短暂性回声增强病变的产科相关因素。
一项对妊娠25至33周出生的单胎早产儿的队列研究。
意大利帕维亚。
349例入住新生儿重症监护病房并接受脑室周围白质软化症筛查的婴儿。
将患有脑室周围囊性白质软化症或脑室周围短暂性回声增强病变的婴儿的产科因素与头颅超声检查结果为阴性的婴儿进行比较。采用逐步多元逻辑回归分析评估风险因素与调整混杂因素后的结局之间的关联。
脑室周围囊性白质软化症和短暂性回声增强病变的患病率分别为5.7%（20/349）和14%（49/349）。囊性白质软化症的主要风险因素为孕早期出血（比值比4.49；95%置信区间1.63 - 12.39）、入院时母体尿路感染（比值比5.71；95%置信区间1.91 - 17.07）以及出生时新生儿酸中毒（pH < 7.2）（比值比5.97；95%置信区间1.93 - 18.52）。羊水胎粪污染（比值比3.95；95%置信区间1.42 - 10.98）和长期（> 72小时）使用利托君进行宫缩抑制（比值比2.54；95%置信区间1.28 - 5.05）与回声增强病变风险增加相关。羊水胎粪污染（比值比4.06；95%置信区间1.65 - 10.0）、长期使用利托君进行宫缩抑制（比值比2.56；95%置信区间1.38 - 4.72）、母体感染（比值比1.73；95%置信区间1.0 - 3.0）以及出生时酸中毒（比值比1.98；95%置信区间1.0 - 3.98）的病例中，总体白质软化症（囊性加脑室周围回声增强病变）的可能性增加。
本研究证实母体感染、出生时酸中毒和羊水胎粪污染会增加早产儿脑室周围白质软化症的风险。长期使用利托君似乎会增加短暂性回声增强病变的风险。
