BIRTH ASPHYXIA - INCIDENCE, CLINICAL COURSE AND OUTCOME IN A SWEDISH POPULATION
BIRTH ASPHYXIA - INCIDENCE, CLINICAL COURSE AND OUTCOME IN A SWEDISH POPULATION
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DOI：
10.1111/j.1651-2227.1995.tb13794.x
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发表时间：
1995-08-01
期刊：
影响因子：
3.8
通讯作者：
MILSOM, I
中科院分区：
文献类型：
--
作者：
THORNBERG, E;THIRINGER, K;MILSOM, I
1985-1991年在哥德堡共出生42203例活婴，292例足月儿5分钟Apgar评分< 7。排除了先天畸形、感染和阿片类药物引起的呼吸抑制的婴儿，因此227例婴儿被纳入出生窒息组，这构成了本回顾性研究的基础。65名婴儿出现轻度、中度或重度缺氧缺血性脑病（HIE）的临床体征，另外10名婴儿在接受镇静剂和控制通气后，假定为HIE，但无法分级。5 min Apgar评分< 7分、新生儿窒息和新生儿窒息合并HIE的发生率分别为6.9/1000、5.4/1000和1.8/1000。95%的新生儿仅用气囊和面罩通气复苏，效果良好，而11例使用肾上腺素复苏的新生儿中只有1例效果良好。227名婴儿中有27名发生癫痫发作，其中18名婴儿在出生后12小时内开始癫痫发作。小于胎龄儿（SGA）在出生窒息组中的比例过高，但在出生窒息-HIE组中并非如此。所有重度HIE患儿均死亡或出现神经系统损害。据报道，一半中度HIE婴儿和所有轻度HIE婴儿在18个月大时均正常。每1 000名活产婴儿中有0.3名死亡，每1 000名婴儿中有0.2名因出生窒息而患上神经残疾。残疾为运动障碍（4例）、四肢瘫痪（2例）、痉挛性双瘫（2例）、脑瘫和轻度神经运动功能障碍（1例）。新生儿窒息和新生儿缺氧缺血性脑病的发生率相对较低，这可能与有效的产前保健有关。
A total of 42 203 live infants were born in Goteborg in 1985-1991, and 292 term infants had Apgar scores < 7 at 5 min. Infants with congenital malformations, infections and opioid-induced respiratory depression were excluded and thus 227 infants were included in the birth asphyxia group, which formed the basis of this retrospective study. Clinical signs of mild, moderate or severe hypoxic-ischemic encephalopathy (HIE) were present in 65 infants, and in another 10 infants, sedated and on controlled ventilation, HIE was assumed but grading was not possible. The incidences of Apgar scores < 7 at 5 min, birth asphyxia and birth asphyxia with HIE were 6.9, 5.4 and 1.8 per 1000 live born infants: 95% of infants resuscitated with bag and mask ventilation only, did well, compared with 1 of 11 in whom resuscitation included adrenaline. Seizures occurred in 27 of 227 infants, beginning in 18 infants within 12 h of birth. Small-for-gestational-age (SGA) infants were overrepresented in the birth asphyxia group but not in the birth asphyxia-HIE group. All infants with severe HIE died or developed neurological damage. Half of the infants with moderate, and all of the infants with mild, HIE were reported to be normal at 18 months of age. A total of 0.3 per 1000 live born infants died and 0.2 per 1000 developed a neurological disability related to birth asphyxia. The disabilities were dyskinetic (4), tetraplegic (2), spastic diplegic (2), cerebral palsy and mild neuromotor dysfunction (1). The relatively low incidences of birth asphyxia and HIE were probably due to effective antenatal care.