Clinical chorioamnionitis and the prognosis for very low birth weight infants
Clinical chorioamnionitis and the prognosis for very low birth weight infants
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DOI：
10.1016/s0029-7844(98)00056-8
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发表时间：
1998-05-01
影响因子：
7.2
通讯作者：
Leveno, KJ
中科院分区：
文献类型：
--
作者：
Alexander, JM;Gilstrap, LC;Leveno, KJ
目的：探讨临床绒毛膜羊膜炎对极低出生体重儿新生儿发病率和死亡率的影响。方法：对德克萨斯州达拉斯帕克兰纪念医院1988-1996年间出生的24周或更高胎龄、体重500-1500 g的单胎活产儿进行观察队列分析。绒毛膜羊膜炎的诊断依据是母体发热38摄氏度，并有支持的临床证据，包括胎儿心动过速、子宫压痛和/或有异味的婴儿，以及没有其他感染源。结果：1367例极低出生体重儿中95例(7%)发生绒毛膜羊膜炎。在调整了早产胎膜破裂、妊娠高血压综合征、剖宫产、胎龄和出生体重后，新生儿败血症、呼吸窘迫综合征、出生后24小时内癫痫发作、脑室出血(3级或4级)和脑室周围白质软化均显著增加。脑室出血、脑室周围白质软化和24小时内癫痫发作的优势比分别为2.8(95%可信区间1.6，4.8)、3.4(95%可信区间1.6，7.3)和2.9(95%可信区间1.2，6.8)。结论：临床绒毛膜羊膜炎与极低出生体重儿的新生儿发病率相关。绒毛膜羊膜炎似乎使出生体重极低的婴儿特别容易受到神经损伤。(C)1998年由美国妇产科医师学会授予。
Objective: To determine the effects of clinical chorioamnianitis on neonatal morbidity and mortality in very low birth weight infants.Methods: This was an observational cohort analysis of all singleton live-born infants weighing 500-1500 g at 24 weeks' or greater gestational age and born between 1988 and 1996 at Parkland Memorial Hospital, Dallas, Texas. Chorioamnionitis was diagnosed on the basis of maternal fever of 38C with supporting clinical evidence, which included fetal tachycardia, uterine tenderness, and/or malodorous infant, and the absence of another source of infection. Multiple logistic regression analysis was used to adjust for outcomes of interest.Results: Ninety-five of 1367 very low birth weight infants (7%) were exposed to chorioamnionitis. Neonatal sepsis, respiratory distress syndrome, seizure in the first 24 hours of life, intraventricular hemorrhage (grade 3 or 4), and periventricular leukomalacia were all significantly increased with chorioamnionitis, after adjusting for preterm ruptured membranes, pregnancy-associated hypertension, cesarean birth, gestational age, and birth weight. The odds ratios for intraventricular hemorrhage, periventricular leukomalacia, and seizures in the first 24 hours were 2.8 (95% confidence interval [CI] 1.6, 4.8), 3.4 (95% CI 1.6, 7.3), and 2.9 (95% CI 1.2, 6.8), respectively.Conclusion: Our results suggest a link between clinical chorioamnionitis and several indices of neonatal morbidity in the very low birth weight infant. Chorioamnionitis appears to make the very low birth weight infant particularly vulnerable to neurologic damage. (C) 1998 by The American College of Obstetricians and Gynecologists.