目的 探讨早发型重度子痫前期(ES-PE)对早产儿临床疾病的影响。 方法 前瞻性地选择2016年1月-2017年12月在厦门大学附属第一医院分娩的孕周≤34周的活产早产儿为研究对象,按暴露因素孕母有无重度子痫前期(S-PE)分为研究组与对照组,观察早产儿的临床结局,收集相关资料进行临床分析。 结果 研究期间共出生≤34周的活产早产儿814例,研究组早产儿107例,符合随访条件101例,对照组早产儿707例,符合随访条件640例。研究组早产儿中剖宫产、新生儿出生窒息、中性粒细胞减少症、血小板减少症、院内感染、喂养不耐受、新生儿呼吸窘迫综合征(NRDS)、支气管肺发育不良(BPD)等发生率明显增加,差异有统计学意义(χ2=68.722、13.073、15.759、14.910、5.221、4.515、8.117、4.192, P＜0.05)。研究组平均出生体重低于对照组(t＝-2.120,P＜0.05),平均住院时间明显长于对照组(t＝2.862,P＜0.05),两组新生儿坏死性小肠结肠炎(NEC)、Ⅲ~Ⅳ度早产儿脑室内出血(IVH)、早产儿视网膜病变(ROP)、新生儿死亡率差异无统计学意义(P＞0.05)。结论 早发型重度子痫影响早产儿出生方式和出生体重,增加早产儿并发症的发生率,使其住院时间延长,但未增加死亡率。
Abstract
Objective To discuss the impact of early-onset severe-preeclampsia(ES-PE) on the clinical outcomes of premature infants. Methods All the live-birth preterm infants with gestational age ≤34 weeks, delivered by women with early-onset severe-preeclampsia in the First Affiliated Hospital of Xiamen University from January 2016 to December 2017, were recruited prospectively in this study.Premature infants were divided into study group and control group according to whether their mother had ES-PE during pregnancy or not.The clinical outcomes of the preterm infants were observed, and the related clinical data were collected for analysis. Results Totally 814 live-birth preterm infants with gestational age ≤34 weeks were delivered during this study period, with 107 in study group and 707 in control group.Finally infants who met the follow-up criteria in the study group and control group were 101 and 640 cases, respectively.Compared with control group, the incidence rates of cesarean section, neonatal birth asphyxia, neutropenia, thrombocytopenia, nosocomial infections, feeding intolerance, neonatal respiratory distress syndrome (NRDS) and bronchopulmonary dysplasia (BPD) increased significantly in study group(χ2=68.722, 13.073, 15.759, 14.910, 5.221, 4.515, 8.117, 4.192, P＜0.05).The average birth weight of the study group was less than that of control group (t=-2.120, P＜0.05), while the average hospitalization day of the study group was longer than that of the control group (t=2.862, P＜0.05) between the two groups(P＞0.05). Conclusion ES-PE affects the birth way and birth weight of preterm infants, increases adverse events rate, hospitalization day in preterm infants, but has no impact on neonatal mortality.
关键词
结局 /
婴儿 /
早产 /
重度子痫 /
早发型
Key words
outcome /
infant /
premature /
severe preeclampsia /
early-onset
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参考文献
[1] Ajah LO, Ozonu NC, Ezeonu PO, et al.The feto-maternal outcome of preeclampsia with severe features and eclampsia in abakaliki, south-east Nigeria[J].J Clin Diagn Res, 2016,10(9):18-21.
[2] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].5版.北京:人民卫生出版社,2019:83-1025.
[3] 谢辛,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:64-71.
[4] Gestational hypertension and preeclampsia in pregnancy.ACOG Practice Bulletin No.202.Gestational hypertension and preeclampsia[J].Obstet Gynecol, 2019,133(1):e1-e25.
[5] 詹实娜,尉进茜,李飞天,等.妊娠高血压合并子痫前期对新生儿结局探讨[J].系统医学,2016,1(9):115-117.
[6] 杨蕊,李红真,乔杰.辅助生殖技术对妊娠结局的影响及处置策略[J].中华围产医学杂志,2014, 17(9):577-580.
[7] 王晨,王丹华.极低出生体重儿早发血小板减少症多因素相关分析[J].中国新生儿科杂志,2015, 30 (2):81-84.
[8] Cakir SC, Dorum BA, Koksal N, et al.The effects of maternal preeclampsia on inflammatory cytokines and clinical outcomes in premature infants[J].Pak J Med Sci,2020,36(2):26-31.
[9] Ulusoy E, Tufekgi O, Duman N,et al.Thrombocytopenia in neonates:causes and outcomes[J].Ann Hematol, 2013, 92:961-967.
[10] Tsao PN, Wei SCh, Su YN, et al.Excess soluble fms-like tyrosine kinase 1 and low platelet counts in premature neonates of preeclamptic mothers[J].Pediatrics, 2005,116:468-472.
[11] Koenig JM,Christensen RD.Incidence, neutrophil kinetics, and natural history of neonatal neutropenia associated with maternal hypertension[J].N Engl J Med, 1989,321(9):557-562.
[12] Mouzinho A, Rosenfeld CR, Sanchez PJ, et al.Effect of maternal hypertension on neonatal neutropenia a risk of nosocomial infection[J].Pediatrics, 1992, 90(3):430-435.
[13] Nayeri UA, Buhimschi CS, Zhao GM, et al.Components of the antepartum,intrapartum,and postpartum exposome impact on distinct short-term adverse neonatal outcomes of premature infants:a prospective cohort study[J].PLoS ONE, 2018,13(12):e0207298.
[14] Rios DRA,Alpoim PN, Godoi LC, et al.Increased levels of SENG and sVCAM-1 and decreased levels of VEGF in severe preeclampsia[J].Pregnancy Hypertens, 2016, 6(4):295-299.
[15] Li X, Zhang WS, Lin JH,et al.Preterm birth,low birthweight,and small for gestational age among women with preeclampsia:does maternal age matter?[J]. Pregnancy Hypertension, 2018,13:260-266.
[16] Rocha GM,Delima FF, Machado AP, et al.Hypertensive disorders during pregnancy and risk of bronchopulmonary dysplasia in very preterm infants[J].Am J Perinatol, 2019,36(2):176-183.
[17] Yen TA,Yang HI,Hsieh WS,et al.Preeclampsia and the risk of bronchopulmonary dysplasia in VLBW infants:a population based study[J].PLoS ONE, 2013, 9(8):e75168.
[18] Suppo de Souza Rugolo LM,Bentlin MR,Petean Trindade CE.Preeclampsia:early and late neonatal outcomes[J].Neo Reviews, 2012,13(9):e532-e541.
[19] Shepherd E, Salam RA, Middleton P, et al.Antenatal andintrapartum interventions for preventing cerebral palsy:an overview of Cochrane systematic reviews[J].Cochrane Database Syst Rev, 2017,8(8):CD012077.
[20] Jelin AC,Cheng YW,Shaffer BL,et al.Early-onset preeclampsia and neonatal outcomes[J].J Matern Fetal Neonatal Med, 2010, 23(5):389-392.
[21] van Oostwaard MF, van Eerden L, de Laat MW, et al.Maternal and neonatal outcomes in women with severe early onset pre-eclampsia before 26 weeks of gestation,a case series[J].BJOG, 2017,124(9):1440-1447.
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