Incidence and prediction of outcome in hypoxic-ischemic encephalopathy in Japan.
Incidence and prediction of outcome in hypoxic-ischemic encephalopathy in Japan.
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DOI：
10.1111/ped.12233
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发表时间：
2014-04
期刊：
影响因子：
--
通讯作者：
Executive Committee, Symposium on Japan Society of Perinatal and Neonatal Medicine
中科院分区：
文献类型：
--
作者：
Hayakawa M;Ito Y;Saito S;Mitsuda N;Hosono S;Yoda H;Cho K;Otsuki K;Ibara S;Terui K;Masumoto K;Murakoshi T;Nakai A;Tanaka M;Nakamura T;Executive Committee, Symposium on Japan Society of Perinatal and Neonatal Medicine
缺氧缺血性脑病（HIE）是新生儿医学中最严重的病理条件之一，因为它可能在以后的生活中造成神经功能缺损。我们调查了日本足月新生儿中度或重度HIE的发病率，并确定了HIE预后不良的预后危险因素。通过对263家医院的全国性调查，收集了2008年1月至12月出生的227名诊断为中度或重度HIE的婴儿的数据。使用逻辑回归，我们研究了母亲，产前，产时和新生儿的危险因素和临床结果之间的关系，在出生后18个月。在日本，中度或重度HIE的发病率为0.37/1000足月活产。早产儿、5分钟低Apgar评分、使用肾上腺素和低脐带血pH值是与神经发育延迟和18个月时死亡显著相关的分娩期因素。预后不良的婴儿血清乳酸、乳酸脱氢酶、天冬氨酸氨基转移酶、丙氨酸氨基转移酶（均P < 0.001）和肌酸激酶（P = 0.002）显著高于预后良好的婴儿。脑磁共振成像（MRI）异常是一个重要的预后因素，与不良预后显著相关（比值比，11.57; 95%可信区间：5.66-23.64; P < 0.001）。预测HIE预后不良的危险因素包括早产、5分钟Apgar评分低、使用肾上腺素、实验室检查异常和MRI异常。
Hypoxic–ischemic encephalopathy (HIE) is one of the most critical pathologic conditions in neonatal medicine due to the potential for neurological deficits in later life. We investigated the incidence of term infants with moderate or severe HIE in Japan and identified prognostic risk factors for poor outcome in HIE. Data on 227 infants diagnosed with moderate or severe HIE and born between January and December 2008 were collected via nationwide surveys from 263 responding hospitals. Using logistic regression, we examined the relationship between maternal, antepartum, intrapartum, and neonatal risk factors and clinical outcome at 18 months following birth. In Japan, the incidence of moderate or severe HIE was 0.37 per 1000 term live births. Outborn births, low Apgar score at 5 min, use of epinephrine, and low cord blood pH were intrapartum factors significantly associated with neurodevelopmental delay and death at 18 months. Serum lactate, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase (all, P < 0.001) and creatine kinase (P = 0.002) were significantly higher in infants with poor outcome compared to those with favorable outcomes. Abnormal brain magnetic resonance imaging (MRI), an important prognostic factor, was significantly associated with poor outcome (odds ratio, 11.57; 95% confidence interval: 5.66–23.64; P < 0.001). Risk factors predicting poor outcome in HIE include outborn birth, low Apgar score at 5 min, use of epinephrine, laboratory abnormalities, and abnormal MRI findings.
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影响因子：
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作者：
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