Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study
Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study
复制标题
DOI：
10.1136/bmj.317.7172.1549
复制
发表时间：
1998-12-05
影响因子：
105.7
通讯作者：
Stanley, FJ
中科院分区：
文献类型：
--
作者：
Badawi, N;Kurinczuk, JJ;Stanley, FJ
目的探讨足月新生儿脑病的产前预测因素，设计以人群为基础的非匹配病例对照研究，研究地点为西澳大利亚州大都会区，研究对象为164例中、重度新生儿脑病的足月儿; 400名随机选择的对照组。主要结果测量校正的比值比估计。结果中度或重度新生儿的出生患病率脑病为3.8/1000例足月活产。新生儿病死率为9.1%。新生儿脑病的风险随着母亲年龄的增加而增加，随着产次的增加而降低。母亲失业（优势比3.60）、非熟练体力劳动者（3.84）或家庭主妇（2.48）的风险增加。怀孕前的其他风险因素包括没有私人健康保险（3.46），癫痫发作家族史（2.55），神经系统疾病家族史（2.73）和不孕症治疗（4.43）。妊娠期间的风险因素包括母亲甲状腺疾病（9.7）、重度先兆子痫（6.30）、中度或重度出血（3.57）、临床诊断的病毒性疾病（2.97）、未饮酒（2.91）;以及分娩时描述为异常的胎盘（2.07）。与婴儿相关的因素是出生体重调整胎龄在第三和第九百分位数之间（4.37）或低于第三百分位数（38.23）。与胎龄的风险关系为J形，38和39周的风险最低。结论新生儿脑病的原因是异质性的，许多因果关系的途径开始于出生前。
Objective To ascertain antepartum predictors of newborn encephalopathy in term infants.Design Population based, unmatched case-control study.Setting Metropolitan area of Western Australia,June 1993 to September 1995.Subjects All 164 term infants with moderate or severe newborn encephalopathy; 400 randomly selected controls.Main outcome measures Adjusted odds ratio estimates.Results The birth prevalence of moderate or severe newborn encephalopathy was 3.8/1000 term live births. The neonatal fatality was 9.1%. The risk of newborn encephalopathy increased with increasing maternal age and decreased with increasing parity. There was an increased risk associated with having a mother who was unemployed (odds ratio 3.60), an unskilled manual worker (3.84), or a housewife (2.48). Other risk factors from before conception were not having private health insurance (3.46), a family history of seizures (2.55), a family history of neurological disease (2.73), and infertility treatment (4.43). Risk factors during pregnancy were maternal thyroid disease (9.7), severe pre-eclampsia (6.30), moderate or severe bleeding (3.57), a clinically diagnosed viral illness (2.97), not having drunk alcohol (2.91); and placenta described at delivery as abnormal (2.07). Factors related to the baby were birth weight adjusted for gestational age between the third and ninth centile (4.37) or below the third centile (38.23). The risk relation with gestational age was J shaped with 38 and 39 weeks having the lowest risk.Conclusions The causes of newborn encephalopathy are heterogeneous and many of the causal pathways start before birth.