Maternal infection and cerebral palsy in infants of normal birth weight
Maternal infection and cerebral palsy in infants of normal birth weight
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DOI：
10.1001/jama.278.3.207
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发表时间：
1997-07-16
影响因子：
120.7
通讯作者：
Nelson, KB
中科院分区：
文献类型：
--
作者：
Grether, JK;Nelson, KB
背景：暴露于母体或胎盘感染与早产风险相关，对于早产儿，则与可预测脑瘫 (CP) 的脑损伤风险相关。很少有研究调查母体感染是否与正常出生体重儿童的 CP 风险相关。目的。-调查出生体重 2500 克或以上的婴儿入院分娩期间的母体感染是否为 CP 的可能危险因素。设计。-基于人群的病例对照研究。背景。-1983 年至 1985 年北加州 4 个县的所有医院。参与者。-总共 46 名患有残疾性痉挛性 CP 的儿童，没有公认的产前脑损伤，并且随机选择 378 名出生时体重 2500 克或以上并存活至 3 岁的对照儿童。主要结果指标。-致残痉挛性 CP 和新生儿发病迹象。结果。-产妇在分娩时发烧超过 38 摄氏度与不明原因 CP 的风险增加相关（比值比 [OR]，9.3；95% 置信区间 [CI]， 2.7-31.0），绒毛膜羊膜炎的临床诊断也是如此。 2.9% 的对照儿童、22% 的 CP 儿童（OR，9.3；95% CI，3.7-23.0）和 35% 的 CP 痉挛性四肢瘫痪亚型儿童（OR，19.0；95% CI，6.5-56.0）存在一种或多种母体感染指标。暴露于母体感染的新生儿（无论是病例还是对照组）的 5 分钟阿普加评分低于 6 分的情况比未暴露的新生儿要多。在患有 CP 的儿童中，感染妇女所生的儿童更常出现低血压、需要插管、新生儿癫痫发作以及缺氧缺血性脑病的临床诊断。结论：宫内暴露于母体感染与正常出生体重婴儿患 CP 的风险显着增加相关。母体感染还与低阿普加评分、高血压和复苏需要的其他证据以及通常归因于出生窒息的新生儿癫痫症状有关。
Context.-Exposure to maternal or placental infection is related to risk of preterm birth and, in premature infants, of brain lesions predictive of cerebral palsy (CP). Few studies have investigated whether maternal infection is associated with risk of CP in children of normal birth weight.Objective.-To investigate maternal infection during the admission for delivery as a possible risk factor for CP in infants born weighing 2500 g or more.Design.-Population-based case-control study.Setting.-All hospitals in 4 northern California counties, 1983 through 1985.Participants.-A total of 46 children with disabling spastic CP who had no recognized prenatal brain lesions and 378 randomly selected control children weighing 2500 g or more at birth and surviving to age 3 years.Main Outcome Measures.-Disabling spastic CP and signs of neonatal morbidity.Results.-Maternal fever exceeding 38 degrees C in labor was associated with increased risk of unexplained CP (odds ratio [OR], 9.3; 95% confidence interval [CI], 2.7-31.0), as was a clinical diagnosis of chorioamnionitis. One or more indicators of maternal infection were present in 2.9% of control children, 22% of children with CP (OR, 9.3; 95% CI, 3.7-23.0), and 35% of those with the spastic quadriplegic subtype of CP (OR, 19.0; 95% CI, 6.5-56.0). Newborns exposed to maternal infection, both cases and controls, had 5-minute Apgar scores below 6 more often than those unexposed. Among children with CP, those born to infected women were more often hypotensive, needed intubation, had neonatal seizures, and received a clinical diagnosis of hypoxic-ischemic encephalopathy.Conclusion.-Intrauterine exposure to maternal infection was associated with a marked increase in risk of CP in infants of normal birth weight. Maternal infection was also linked with low Apgar scores, other evidence of hypertension and need for resuscitation, and neonatal seizures-signs commonly attributed to birth asphyxia.