Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis.

Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis.
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DOI:
10.1136/bmj.c1471
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发表时间:
2010-05-13
期刊:
BMJ (Clinical research ed.)
影响因子:
--
通讯作者:
Khan KS
Khan KS
中科院分区:
其他
文献类型:
--
作者:
Malin GL;Morris RK;Khan KS

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目的探讨出生时脐带pH值与远期预后的关系。设计系统综述和荟萃分析。数据来源Medline(1966- 2008年8月)、Embase(1980- 2008年8月)、科克伦图书馆(2008年第8期)和Medion,无语言限制;选定文章的参考文献列表;与作者联系。研究选择将出生时脐带pH值与任何新生儿或长期结局进行比较的研究。包括队列和病例对照设计。结果符合入选标准的文献51篇,共481 753名婴儿。研究在设计、质量、结局定义和结果方面各不相同。在预定组内进行的荟萃分析显示,动脉脐带pH值低与新生儿死亡率显著相关(比值比16.9,95%置信区间9.7 - 29.5,I2=0%),缺氧缺血性脑病(13.8,6.6 - 28.9,I2=0%)、脑室内出血或脑室周围白质软化(2.9,2.1 - 4.1,I2=0%)和脑瘫(2.3,1.3 - 4.2,I2=0%)。结论:低动脉脐带pH值与临床上重要的新生儿结局具有强的、一致的和暂时的相关性,这在生物学上是合理的。这些数据可用于通知临床管理,并证明使用动脉脐带pH值作为产科试验中新生儿发病率和死亡率的重要结局指标。
Objective To evaluate the association between umbilical cord pH at birth and long term outcomes. Design Systematic review and meta-analysis. Data sources Medline (1966-August 2008), Embase (1980-August 2008), the Cochrane Library (2008 issue 8), and Medion, without language restrictions; reference lists of selected articles; and contact with authors. Study selection Studies in which cord pH at birth was compared with any neonatal or long term outcome. Cohort and case-control designs were included. Results 51 articles totalling 481 753 infants met the selection criteria. Studies varied in design, quality, outcome definition, and results. Meta-analysis carried out within predefined groups showed that low arterial cord pH was significantly associated with neonatal mortality (odds ratio 16.9, 95% confidence interval 9.7 to 29.5, I2=0%), hypoxic ischaemic encephalopathy (13.8, 6.6 to 28.9, I2=0%), intraventricular haemorrhage or periventricular leucomalacia (2.9, 2.1 to 4.1, I2=0%), and cerebral palsy (2.3, 1.3 to 4.2, I2=0%). Conclusions Low arterial cord pH showed strong, consistent, and temporal associations with clinically important neonatal outcomes that are biologically plausible. These data can be used to inform clinical management and justify the use of arterial cord pH as an important outcome measure alongside neonatal morbidity and mortality in obstetric trials.
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