Maternal, neonatal, and placental features associated with diffuse chorioamniotic hemosiderosis, with special reference to neonatal morbidity and mortality
Maternal, neonatal, and placental features associated with diffuse chorioamniotic hemosiderosis, with special reference to neonatal morbidity and mortality
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DOI：
10.1542/peds.113.4.800
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发表时间：
2004-04-01
期刊：
影响因子：
8
通讯作者：
Tanaka, Y
中科院分区：
文献类型：
--
作者：
Ohyama, M;Itani, Y;Tanaka, Y
目标。我们的目的是探讨弥漫性绒毛羊膜含铁血黄素沉着症(DCH)对新生儿发病率和死亡率的意义。采用回顾性病例对照研究方法，对1987-2001年在神奈川儿童医学中心新生儿重症监护室分娩的46例DCH单胎胎盘和92例非DCH单胎胎盘进行分析。DCH组胎龄平均为27+/-3周，标准差为939+/-342g。宏观上，DCH胎盘更容易出现陈旧的外周血块(DCH组46%比对照组8%)、绒毛膜下血肿(20%比1%)和围绝带(13%比1%)。组织学上，DCH组的羊膜坏死率明显更高(63%比24%)。在产科因素中，DCH组再发阴道出血(70%vs 11%)、羊水过少(59%vs 8%)、慢性早剥羊水过少(57%vs 5%)发生率明显高于对照组。在新生儿因素中，新生儿持续性肺动脉高压(29%比8%)和干燥肺和/或肺发育不良(20%比4%)更为常见。然而，呼吸窘迫综合征在DCH组中很少见(15%比45%)。DCH组新生儿死亡(包括死产)有所增加，但差异不显著(24%对15%)。在存活超过28天的婴儿中，慢性肺部疾病(CLD)在DCH组中更常见(51%比22%)。通过似然比检验，DCH，尤其是伴有羊膜坏死的DCH与CLD的相关性仍然很明显。DCH与早产、新生儿肺动脉高压和干肺综合征密切相关，是CLD的重要危险因素。
Objective. Our purpose was to examine the significance of diffuse chorioamniotic hemosiderosis (DCH) on neonatal morbidity and mortality.Methods. Using data from a retrospective case-control study, we analyzed 46 singleton placentas with DCH from infants who were delivered and/or admitted to the neonatal intensive care unit of Kanagawa Children's Medical Center during 1987 - 2001 and 92 control placentas without DCH from infants of comparable gestational age, birth weight, and duration.Results. Mean and standard deviation of gestational age and infants' birth weight at delivery from the DCH group were 27 +/- 3 weeks and 939 +/- 342 g, respectively. Macroscopically, the placentas with DCH were more likely to show old peripheral blood clots (46% in the DCH group vs 8% in control group), subchorionic hematoma (20% vs 1%), and circumvallation (13% vs 1%). Histologically, amniotic necrosis was significantly more frequent in the DCH group (63% vs 24%). Of the obstetric factors, incidence of recurrent episodes of vaginal bleeding (70% vs 11%), oligohydramnios (59% vs 8%), and chronic abruption-oligohydramnios sequence (57% vs 5%) were significantly higher in the DCH group. Of the neonatal factors, persistent pulmonary hypertension of the newborn (29% vs 8%) and dry lung and/or pulmonary hypoplasia ( 20% vs 4%) were more common. However, respiratory distress syndrome was rare (15% vs 45%) in the DCH group. Neonatal death including stillbirth was increased in the DCH group but was not significant ( 24% vs 15%). Of infants who survived beyond day 28, chronic lung disease (CLD) was more frequent in the DCH group (51% vs 22%). The association of DCH, especially accompanied by amniotic necrosis, with CLD was still evident using likelihood ratio test.Conclusion. DCH is closely associated with preterm delivery, pulmonary hypertension of the newborn, and dry lung syndrome and is a significant risk factor for CLD.