Is perinatal asphyxia predictable?
Is perinatal asphyxia predictable?
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DOI：
10.1186/s12884-020-02876-1
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发表时间：
2020-03-30
影响因子：
3.1
通讯作者：
Paterlini, Giuseppe
中科院分区：
文献类型：
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作者：
Locatelli, Anna;Lambicchi, Laura;Paterlini, Giuseppe
背景本研究的目的是评估围产期窒息与新生儿缺氧缺血性脑病(HIE)的关系，以改善母婴管理。方法2014-2016年间，我们从四家医院(一家设有新生儿重症监护室的中心和三家I级说话中心)的网络中进行前瞻性观察队列研究。如果诊断为围产期窒息，包括胎龄<35周，出生体重=1800g，无致命畸形的新生儿，定义为pH=5的新生儿被转移到Hub进行进一步评估；如果TS>；=7体温过低。结果围产期窒息发生率为21.5‰(321/14,896)，HIE发生率为1.1‰(16/14,896)。研究人群包括281名窒息新生儿：出生在Hub的68/5152(1.3%)，出生在Spokes的213/9744(2.2%)(P<；0.001，OR 0.59，95%CI 0.45-0.79)。32/213(15%)新生儿从Spokes转至Hub。总体而言，281例患者中有12例接受了亚低温治疗。新生儿缺氧缺血性脑病发生率为5.7%(16/281)，其中I级4例，II级8例，III级4例。导致新生儿窒息的妊娠分类为1)1.1%，2)52.3%，3)3.2%，4)43.4%。23.5%的病例发生前哨事件，50.5%的病例FHR为II或III级。40.2%的窒息和18.8%的HIE患者无前哨事件或FHR异常。结论我们发现至少有一个危险因素与所有HIE病例和大多数围产期窒息病例有关。在没有危险因素的情况下，发生围产期窒息的概率极低。胎心率监测本身并不是检测最终窒息概率的可靠工具。
Background The objective of our study was to evaluate the association between perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE) with the presence of ante and intrapartum risk factors and/or abnormal fetal heart rate (FHR) findings, in order to improve maternal and neonatal management. Methods We did a prospective observational cohort study from a network of four hospitals (one Hub center with neonatal intensive care unit and three level I Spoke centers) between 2014 and 2016. Neonates of gestational age >= 35 weeks, birthweight >= 1800 g, without lethal malformations were included if diagnosed with perinatal asphyxia, defined as pH = 5 neonates were transferred to Hub for further assessment; if TS >= 7 hypothermia was indicated. Results Perinatal asphyxia occurred in 21.5 parts per thousand cases (321/14,896) and HIE in 1.1 parts per thousand (16/14,896). The total study population was composed of 281 asphyxiated neonates: 68/5152 (1.3%) born at Hub and 213/9744 (2.2%) at Spokes (p < 0.001, OR 0.59, 95% CI 0.45-0.79). 32/213 (15%) neonates were transferred from Spokes to Hub. Overall, 12/281 were treated with hypothermia. HIE occurred in 16/281 (5.7%) neonates: four grade I, eight grade II and four grade III. Incidence of HIE was not different between Hub and Spokes. Pregnancies resulting in asphyxiated neonates were classified as class 1) 1.1%, 2) 52.3%, 3) 3.2%, and 4) 43.4%. Sentinel events occurred in 23.5% of the cases and FHR was category II or III in 50.5% of the cases. 40.2% cases of asphyxia and 18.8% cases of HIE were not preceded by sentinel events or abnormal FHR. Conclusions We identified at least one risk factor associated with all cases of HIE and with most cases of perinatal asphyxia. In absence of risk factors, the probability of developing perinatal asphyxia resulted extremely low. FHR monitoring alone is not a reliable tool for detecting the probability of eventual asphyxia.