Wayenberg J L, Vermeylen D, Damis E
Service de pédiatrie, hôpital français Reine-Elisabeth, Bruxelles, Belgique.
Arch Pediatr. 1998 Oct;5(10):1065-71. doi: 10.1016/s0929-693x(99)80002-5.
In a prospective multicentric study, 152 of 10,065 live term births had birth asphyxia, defined by the association of three indicators (fetal distress, depression at birth and metabolic acidosis).
The incidence of birth asphyxia was 1.5% of live term births when birth asphyxia was defined by the presence of at least two indicators, and 1% of live term births when birth asphyxia was defined by the association of metabolic acidosis and another indicator. Neurological complications were observed in 66 cases (43%). The incidence of post-asphyxial encephalopathy (PAE) was 5.9/1000 of live term births (mild PAE: 3/1000; moderate PAE: 2.7/1000; severe PAE: 0.2/1000). Systemic complications were observed in 87 patients (57%). Renal injury and coagulopathy were associated with moderate or severe PAE. Respiratory complications (39%), infections (17%) and gastro-intestinal intolerance (15%) often complicated the course. Severe complications were never seen in the absence of significant metabolic acidosis at 30 minutes of life.
Our study has many implications concerning the diagnosis of birth asphyxia and its complications. A terminology based on clinical observation and arterial pH evaluation is proposed in order to clarify the situation.
在一项前瞻性多中心研究中，10065例足月活产中有152例发生出生窒息，其定义为三项指标（胎儿窘迫、出生时抑制和代谢性酸中毒）同时存在。
当出生窒息由至少两项指标定义时，其发生率为足月活产的1.5%；当出生窒息由代谢性酸中毒与另一项指标同时存在定义时，其发生率为足月活产的1%。观察到66例（43%）有神经系统并发症。出生窒息后脑病（PAE）的发生率为每1000例足月活产中有5.9例（轻度PAE：每1000例中有3例；中度PAE：每1000例中有2.7例；重度PAE：每1000例中有0.2例）。观察到87例（57%）有全身并发症。肾损伤和凝血病与中度或重度PAE相关。呼吸并发症（39%）、感染（17%）和胃肠道不耐受（15%）常使病程复杂化。在出生后30分钟时若无明显代谢性酸中毒，则从未见过严重并发症。
我们的研究在出生窒息及其并发症的诊断方面有许多启示。为了澄清情况，提出了一种基于临床观察和动脉血pH评估的术语。
