Incidence and risk factors for cerebral palsy in infants with perinatal problems: A 15-year review
Incidence and risk factors for cerebral palsy in infants with perinatal problems: A 15-year review
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DOI：
10.1016/j.earlhumdev.2006.10.004
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发表时间：
2007-08-01
影响因子：
2.5
通讯作者：
Andronikou, S.
中科院分区：
文献类型：
--
作者：
Drougia, A.;Giapros, V.;Andronikou, S.
目的：脑瘫（CP）与产前、围产期和产后因素有关。这是一项回顾性病例对照研究，旨在确定在希腊西北部新生儿重症监护病房（NICU）护理的婴儿中CP的频率并检查CP的危险因素。设计和患者：所有1989-2003年期间入住NICU并随后发展为CP的新生儿都被纳入研究，并有匹配的对照组。根据胎龄（GA）评估CP的发生率：GA < 34周（A组）和GA≤34周（B组），研究时间：1989-1996年（第1期）和1997-2003年（第11期，期间使用宫内移植和产前类固醇）。结果：78例患儿确诊CP，其中A组55例，b组23例。CP的发生率随GA的降低而显著升高。在第二阶段，GA < 34周的儿童无CP的生存率显著增加。通过多因素分析确定与CP相关的主要因素为（优势比，置信区间），A组：第一期胎龄小（SGA）（2.5, 1.2-4.5）和动脉导管未闭（PDA）（3.4, 1.3-9.2），心室周围白质软化（PVL）（27, 4.8-209），膜破裂时间延长（PROM）（5.6, 1.8-18）和机械通气时间（1.1,1.05-1.2），B组：SGA(3.6, 1.39.9)，新生儿转移（3.06,1.2-7.6），机械通气时间（1.1,1.06-1.25）和败血症-脑膜炎（4.3,1.2-16）。结论：在研究后期，GA < 34周的婴儿无CP的生存率有所提高，早产儿CP的危险因素与研究期有关。PVL、PROM和PDA是GA < 34周患儿CP和GA < 34周患儿SGA、新生儿转移和败血症/脑膜炎最有效的独立预测因子。2006爱思唯尔爱尔兰有限公司版权所有。
Objective: Cerebral palsy (CP) is associated with prenatal, perinatal and postnatal factors. This is a retrospective case-control study aiming to determine the frequency of CP and examine risk factors for CP among infants cared for in the Neonatal Intensive Care Unit (NICU) covering Northwest Greece.Design and patients: All neonates who were admitted to the NICU during the period 1989-2003 inclusive, and subsequently developed CP, were enrolled in the study, with matched controls. The incidence of CP was evaluated according to gestational age (GA): GA < 34 weeks (group A) and GA > 34 (group B), and study period: 1989-1996 (period 1) and 1997-2003 (period 11, during which intrauterine transfer and prenatal steroids were used). Results: CP was diagnosed in 78 children, 55 in group A and 23 in group B. The incidence of CP increased significantly with decreasing GA. Survival without CP increased significantly in children of GA < 34 weeks during period II. The main factors associated with CP, identified by multivariate analysis, were (odds ratios, confidence interval), for group A: being small for gestational age (SGA) (2.5, 1.2-4.5) and patent ductus arteriosus (PDA) (3.4, 1.3-9.2) in period 1, periventricular leucomalacia (PVL) (27, 4.8-209), prolonged rupture of membranes (PROM) (5.6, 1.8-18) and duration of mechanical ventilation (1.1, 1.05-1.2) in period 11, and for group B: SGA (3.6, 1.39.9), neonatal transfer (3.06, 1.2-7.6), duration of mechanical ventilation (1.1, 1.06-1.25) and sepsis-meningitis (4.3, 1.2-16).Conclusion: Improvement in survival without CP was observed in infants of GA < 34 weeks during the later period of the study, and risk factors for CP in preterm infants depended on the study period. PVL, PROM and PDA were the most powerful independent predictors of CP in children of GA < 34 weeks and SGA, neonatal transfer and sepsis/meningitis in children of GA > 34 weeks. (c) 2006 Elsevier Ireland Ltd. All rights reserved.