Risk factors for persistent pulmonary hypertension of the newborn
Risk factors for persistent pulmonary hypertension of the newborn
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DOI：
10.1542/peds.2006-3037
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发表时间：
2007-08-01
期刊：
影响因子：
8
通讯作者：
Mitchell, Allen A.
中科院分区：
文献类型：
--
作者：
Hernandez-Diaz, Sonia;Van Marter, Linda J.;Mitchell, Allen A.
目标。新生儿持续性肺动脉高压是一种临床综合征，由胎儿到新生儿正常循环过渡失败引起，与大量婴儿死亡率和发病率相关。我们进行了一项病例对照研究，以确定新生儿持续肺动脉高压的可能的产前和围产期预测因素。1998年至2003年间，斯隆流行病学中心招募了377名患有持续性肺动脉高压新生儿的母亲和836名匹配对照对象的母亲。在分娩后6个月内，研究护士就人口统计学、医学和产科特征对参与者进行了访谈。与新生儿持续性肺动脉高压风险升高独立相关的因素是男婴的性别和黑人或亚洲母亲的种族与白人相比。高孕前体重指数（bbb27 vs < 20）也与新生儿的持续性肺动脉高压有关，糖尿病和哮喘也是如此。与阴道分娩的婴儿相比，剖宫产出生的新生儿发生持续性肺动脉高压的风险更高。与妊娠37至41周内出生的婴儿相比，妊娠34至37周之间出生的婴儿以及41周以上出生的婴儿的风险更高。与胎龄分布在出生体重第10百分位和第90百分位以内的婴儿相比，第90百分位以上的婴儿的风险更高。我们的研究结果表明，剖宫产会增加新生儿持续性肺动脉高压的风险；晚期早产或早产；大的：比胎龄大的；母亲是黑人或亚洲人，超重，糖尿病和哮喘。目前尚不清楚这些因素中是否有一些是新生儿持续性肺动脉高压的直接原因，还是仅仅与之有共同的原因；然而，临床医生应该警惕对有这些危险因素的孕妇进行监测和干预的需求增加。
Objective. Persistent pulmonary hypertension of the newborn, a clinical syndrome that results from the failure of the normal fetal-to-neonatal circulatory transition, is associated with substantial infant mortality and morbidity. We performed a case-control study to determine possible antenatal and perinatal predictors of persistent pulmonary hypertension of the newborn.Methods. Between 1998 and 2003, the Slone Epidemiology Center enrolled 377 mothers of infants with persistent pulmonary hypertension of the newborn and 836 mothers of matched control subjects. Within 6 months of delivery, study nurses interviewed participants regarding demographic, medical, and obstetric characteristics.Results. Factors that were independently associated with an elevated risk for persistent pulmonary hypertension of the newborn were infant male gender and black or Asian maternal race compared with white race. High prepregnancy BMI (> 27 vs < 20) was also associated with persistent pulmonary hypertension of the newborn, as were diabetes and asthma. Compared with infants who were delivered vaginally, the risk for persistent pulmonary hypertension of the newborn was higher for those who were born by cesarean section. Compared with infants who were born within 37 to 41 gestational weeks, the risk was higher for those who were born between 34 and 37 completed weeks and for those born beyond 41 weeks. Compared with infants within the 10th and 90th percentiles of birth weight for gestational age distribution, the risk was higher for infants above the 90th percentile.Conclusions. Our findings suggest an increased risk for persistent pulmonary hypertension of the newborn associated with cesarean delivery; late preterm or postterm birth; being large for gestational age; and maternal black or Asian race, overweight, diabetes, and asthma. It remains unclear whether some of these factors are direct causes of persistent pulmonary hypertension of the newborn or simply share common causes with it; however, clinicians should be alert to the increased need for monitoring and intervention among pregnancies with these risk factors.