目的 探讨新生儿出生头围的影响因素,为建立新生儿头围正常参考值范围样本筛选,制定小头畸形诊断标准提供科学依据。方法 收集2014年1月-2017年12月广东省某医院分娩新生儿信息,对48 928例活产单胎新生儿资料使用t检验/单因素方差分析和多因素广义线性回归进行统计分析。结果 新生儿的平均出生头围为(33.4±1.7)cm。新生儿胎龄越大、剖宫产分娩、男性、羊水过多和产妇年龄越大、籍贯隶属北方省份、多孕、多产、合并妊娠期糖尿病导致新生儿出生头围偏大(P<0.05)。新生儿宫内生长受限、脐带绕颈、脐带扭转、羊水过少和产妇妊娠期合并高血压疾病、胆汁淤积症、贫血导致新生儿出生头围偏小(P<0.05)。新生儿结构异常、辅助生殖受孕、羊水浑浊和产妇甲状腺功能异常、瘢痕子宫、前置胎盘和生殖道感染对头围无显著影响(P>0.05)。结论 新生儿出生头围影响因素众多,在制定出生头围正常参考值范围时,除了考虑生理因素的差异,还应排除有相关疾病因素的样本,如宫内生长受限、妊娠期合并症(妊娠期糖尿病、高血压疾病、胆汁淤积症、贫血)、羊水异常、脐带异常等,以确保参考值范围的科学性。
Abstract
Objective To explore the influencing factors of neonatal head circumference,in order to provide basis for sample selection in reference range,and for screening microcephaly in zika virus infection. Methods A total of 48 928 cases born in Guangdong Women and Children′s Hospital were selected in this study from January 2014 to December 2017,and the clinical data were collected retrospectively.The influencing factors of head circumference at birth were analyzed by independent sample t test/variance analysis and multivariate generalized linear regression analysis. Results The average head circumference of neonates was(33.4±1.7)cm.The head circumference of male newborns,children with larger gestational age,neonates whose ancestral homes were from northern China,delivered by cesarean section and older pregnant women,children exposed to hydramnios multiple pregnancy,multiparity,gestational diabetes mellitus was larger(P<0.05).And the head circumference of children exposed to intrauterine growth restriction,umbilical cord around neck,umbilical cord torsion,oligohydramnios and gestational hypertension,cholestasis,anemia was smaller(P<0.05).There were no significant differences on head circumference among neonates with abnormal structure,assisted reproductive,amniotic fluid characteristics,maternal thyroid function,scarred uterus,placenta previa and reproductive tract infection(P>0.05). Conclusions The neonatal head circumference is influenced by many factors.When formulating the reference range of normal birth head circumference,In addition to considering the differences of physiological factors,it is supposed to exclude samples of related disease factors,such as intrauterine growth restriction,pregnancy complications(gestational diabetes mellitus,hypertension,cholestasis and anemia),abnormal amniotic fluid,umbilical cord abnormalities and so on,so that the scientificity of the reference range can be ensured.
关键词
出生头围 /
影响因素 /
现况研究
Key words
head circumference /
influencing factors /
cross-sectional study
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参考文献
[1] Barbier A,Boivin A,Yoon W,et al.New reference curves for head circumference at birth,by gestational age [J] .Pediatrics,2013,131: e1158-e1167.
[2] 卢桂阳,苏迎盈,汪宁.寨卡病毒病若干流行病学问题[J].中华流行病学杂志,2016,37(4):450-453.
[3] 解珺淑,任梅宏,周静怡,等.WHO“寨卡病毒暴露孕期管理指南”解读[J].中国实用妇产科杂志,2018,34(2):165-170.
[4] WHO.Prevention of potential sexual transmission of Zika virus.http://apps who.inffiris/bitstream/10665/204421/WHO_ZIKV_MOC16.1_eng.pdf7.ua=1.
[5] Jia H,Zhang M,Chen M,et al.Zika virus infection in travelers returning from countries with local transmission,Guangdong,China,2016[J].Travel Med Infect Dis,2018,21: 56-61.
[6] 伦妙栩.广东省胎儿头围正常参考值的研究和头围曲线的建立[D].太原:山西医科大学,2018.
[7] 谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013.
[8] Baghianimoghadam MH,Baghianimoghadam B,Ardian N,et al.Risk factors of low birth weight and effect of them on growth pattern of children up to sixth months of life: A cross-sectional study [J].J Educ Health Promot,2015,4:40.
[9] Lombardo MV,Ashwin E,Auyeung B,et al.Fetal testosterone influences sexually dimorphic gray matter in the human brain[J].J Neuro Sci,2012,32(2):674-680.
[10] Amorim MDST,Melo AN.Revisiting head circumference of Brazilian newborns in public and private maternity hospitals[J].Arq Neuropsiquiatr,2017,75(6):372-380.
[11] 陈兢思,陈敏,蔡光伟,等.羊水基因芯片在中晚孕期的临床应用价值分析[J].实用妇产科杂志,2017,33(4):272-276.
[12] 卫文峰,刘彩娥,赵联营,等.妊娠期脐带异常对新生儿脐血神经元特异性烯醇化酶的影响及临床意义[J].中国计划生育和妇产科,2016,8(6):25-27.
[13] 游燕,陈香军,王丹凤,等.胎儿宫内生长受限 120例病因及妊娠结局分析[J].中国基层医药,2018,25(9):1196-1199.
[14] 雷敏,黄小云,刘惠龙,等.初生儿体格生长与母亲分娩年龄研究[J].中国妇幼卫生杂志,2015,6(2):11-15.
[15] 黄小云,刘惠龙,雷敏,等.初产足月儿与经产足月儿宫内生长水平差异的研究[J].中国当代儿科杂志,2018,20(3):184-188.
[16] Bacci S,Bartolucci F,Chiavarini M,et al.Differences in birt hweight outcomes: a longitudinal study based on siblings[J].Int J Environ Res Public Health,2014,11(6): 6472-6484.
[17] Eviston DP,Minasyan A,Mann KP,et al.Altered fetal head growth in preeclampsia: a retrospective cohort proof-of-concept study[J].Front Pediatr,2015,3(1): 83.
[18] 牛影.妊娠期高血压疾病对出生结局及6月龄婴儿发育行为影响的出生队列研究[D].合肥:安徽医科大学,2016.
[19] 李娜娜.妊娠糖尿病对新生儿出生体格发育的影响[D].郑州:郑州大学,2017.
[20] Mei YW,Lin YH,Luo D,et al.Perinatal outcomes in intrahepatic cholestasis of pregnancy with monochorionic diamniotic twin pregnancy [J] .BMC Pregnancy Childbirth,2018,18(1): 291.
[21] 袁燕.辅助生殖技术后250例单胎的妊娠风险和分娩结局的调查研究[D].南昌:南昌大学,2016.
[22] 贾朝霞,宋培歌,王军华,等.北京地区胎龄别新生儿出生头围分析[J].中国儿童保健杂志,2015,23(6):580-583.
[23] 杨青,易礼兰,张宝林,等.中国四城市足月新生儿体格发育变化调查[J].第三军医大学学报,2016,38(6):652-656.
[24] 黄小云,刘惠龙,雷敏,等.深圳16887例胎龄27～42周新生儿宫内生长体重、身长、头围、胸围、顶臀长曲线[J].中国当代儿科杂志,2017,19(8):877-886.
基金
广东省防控寨卡病毒病科技攻关专项(2016A020249001)
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