基于多中心新生儿头颅MRI研究分娩方式对颅内出血发病风险的影响
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摘要
目的基于MRI诊断分析不同分娩方式对新生儿颅内出血(intracranialhemorrhage,ICH)发病风险的影响。材料与方法回顾性收集6家三甲医院2011年1月至2016年10月出生14 d内行头颅MRI检查的新生儿3464例,排除临床资料不齐全、遗传代谢性疾病、先天性颅脑发育异常、产前颅内出血及MRI图像不能用于分析的病例。通过Logistic回归分析比较暴露于不同分娩方式下新生儿ICH的发病风险。结果纳入1976例新生儿进行分析,Logistic回归模型校正混杂因素后发现,与剖宫产相比,经阴道分娩的新生儿ICH的发病风险提高了4.27倍。进一步将阴道分娩分层,发现经产钳助产分娩的新生儿ICH的发病风险最高,为剖宫产的7.52倍。其中产钳助娩显著提高新生儿室管膜下-脑室内出血、蛛网膜下腔出血、硬膜下出血的发病风险。结论阴道分娩可能增加了新生儿ICH的发病风险,尤其是以产钳助产方式分娩的新生儿。
Objective: To analyze the influence of different delivery methods on the risk of intracranial hemorrhage(ICH) in neonates based on MRI. Materials and Methods: Retrospectively collected 3464 neonates with head MRI within 14 days after the birth of six hospitals(form Jan 2011 to Oct 2016). Cases with incomplete clinical data, inherited metabolic diseases, congenital craniocerebral dysplasia, prenatal intracranial hemorrhage, and MRI images that could not be used for analysis were excluded. Logistic regression analysis was used to compare the risk of neonatal ICH exposure to different modes of delivery. Results: A total of 1976 neonates were included for analysis. The Logistic regression model corrected for confounding factors and found that the risk of neonatal ICH in vaginal delivery increased by 4.27 times compared with cesarean section. Further stratification of vaginal delivery revealed that neonatal delivered by forceps had the highest risk of ICH, which was 7.52 times higher than those delivered by cesarean section. Among them, forceps delivery significantly increased the risk of subependymal-intraventricular hemorrhage, subarachnoid hemorrhage and subdural hemorrhage in neonates. Conclusions: Vaginal delivery may increase the risk of developing neonatal ICH, especially in forceps.
Objective: To analyze the influence of different delivery methods on the risk of intracranial hemorrhage(ICH) in neonates based on MRI. Materials and Methods: Retrospectively collected 3464 neonates with head MRI within 14 days after the birth of six hospitals(form Jan 2011 to Oct 2016). Cases with incomplete clinical data, inherited metabolic diseases, congenital craniocerebral dysplasia, prenatal intracranial hemorrhage, and MRI images that could not be used for analysis were excluded. Logistic regression analysis was used to compare the risk of neonatal ICH exposure to different modes of delivery. Results: A total of 1976 neonates were included for analysis. The Logistic regression model corrected for confounding factors and found that the risk of neonatal ICH in vaginal delivery increased by 4.27 times compared with cesarean section. Further stratification of vaginal delivery revealed that neonatal delivered by forceps had the highest risk of ICH, which was 7.52 times higher than those delivered by cesarean section. Among them, forceps delivery significantly increased the risk of subependymal-intraventricular hemorrhage, subarachnoid hemorrhage and subdural hemorrhage in neonates. Conclusions: Vaginal delivery may increase the risk of developing neonatal ICH, especially in forceps.
引文
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[7]Sun LZ,Cao XH.Surgical production and indications.J Prac Obste Gynecol,2012,28(3):166-168.孙丽洲,曹晓辉.手术产及指征.实用妇产科杂志,2012,28(3):166-168.
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[9]Zhan CY,Duan Q,Qiu SJ,et al.Application of susceptibility weighted imaging(SWI)in diagnosis of neonatal subependymal/intraventricular,intraparenchymal,intracerebral hemorrhage.J Clin Radiol,2011,30(11):1671-1676.詹传银,段青,邱士军,等.3.0 T磁敏感加权成像诊断新生儿室管膜下-脑室内出血、大脑内及小脑内出血.临床放射学杂志,2011,30(11):1671-1676.
[10]Liu ZC.Analysis and prevention of related factors of neonatal subarachnoid hemorrhage.Contemp Med,2011,17(33):68-69.刘智聪.新生儿蛛网膜下腔出血相关因素分析及预防.当代医学,2011,17(33):68-69.
[11]Krüger M,Quaas L,Van Velthoven V,et al.Cerebral parenchymal hemorrhage in mature newborns after normal delivery in normal pregnancy.World Core Med J Abstracts(Gynecology and Obstetrics Volume),2005,1(4):53-54.Krüger M,Quaas L,Van Velthoven V,等.正常妊娠自然分娩后成熟新生儿的脑实质出血.世界核心医学期刊文摘(妇产科学分册),2005,1(4):53-54.
[12]Towner D,Castro MA,Eby-Wilkens E,et al.Effect of mode of delivery in nulliparous women on neonatal intracranial injury.N Engl J Med,1999,341(23):1709-1714.
[13]Werner EF,Janevic TM,Illuzzi J,et al.Mode of delivery in nulliparous women and neonatal intracranial injury.Obstet Gynecol,2011,118(6):1239-1246.
[2]Gamaleldin I,Harding D,Siassakos D,et al.Significant intraventricular hemorrhage is more likely in very preterm infants born by vaginal delivery:A multi-centre retrospective cohort study.J Matern Fetal Neonatal Med,2019,32(3):477-482
[3]Humberg A,Ha?rtel C,Paul P,et al.Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants:observational data of the German Neonatal Network.Eur J Obstet Gynecol Reprod Biol,2017,212:144-149.
[4]Luo XT,Lu YF.Analysis and prevention of related factors of neonatal intracranial hemorrhage.Guangxi Med,2013,35(12):1668-1669.罗香团,陆月凤.新生儿颅内出血的相关因素分析及预防.广西医学,2013,35(12):1668-1669.
[5]Mary AR.MRI of the neonatal brain.London:Harcourt publishers,2002:172.
[6]Rooks VJ,Eaton JP,Ruess L,et al.Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants.AJNR Am JNeuroradiol,2008,29(6):1082-1089.
[7]Sun LZ,Cao XH.Surgical production and indications.J Prac Obste Gynecol,2012,28(3):166-168.孙丽洲,曹晓辉.手术产及指征.实用妇产科杂志,2012,28(3):166-168.
[8]Demissie K,Rhoads GG,Smulian JC,et al.Operative vaginal delivery and neonatal and infant adverse outcomes:population based retrospective analysis.BMJ,2004,329(7456):1-6.
[9]Zhan CY,Duan Q,Qiu SJ,et al.Application of susceptibility weighted imaging(SWI)in diagnosis of neonatal subependymal/intraventricular,intraparenchymal,intracerebral hemorrhage.J Clin Radiol,2011,30(11):1671-1676.詹传银,段青,邱士军,等.3.0 T磁敏感加权成像诊断新生儿室管膜下-脑室内出血、大脑内及小脑内出血.临床放射学杂志,2011,30(11):1671-1676.
[10]Liu ZC.Analysis and prevention of related factors of neonatal subarachnoid hemorrhage.Contemp Med,2011,17(33):68-69.刘智聪.新生儿蛛网膜下腔出血相关因素分析及预防.当代医学,2011,17(33):68-69.
[11]Krüger M,Quaas L,Van Velthoven V,et al.Cerebral parenchymal hemorrhage in mature newborns after normal delivery in normal pregnancy.World Core Med J Abstracts(Gynecology and Obstetrics Volume),2005,1(4):53-54.Krüger M,Quaas L,Van Velthoven V,等.正常妊娠自然分娩后成熟新生儿的脑实质出血.世界核心医学期刊文摘(妇产科学分册),2005,1(4):53-54.
[12]Towner D,Castro MA,Eby-Wilkens E,et al.Effect of mode of delivery in nulliparous women on neonatal intracranial injury.N Engl J Med,1999,341(23):1709-1714.
[13]Werner EF,Janevic TM,Illuzzi J,et al.Mode of delivery in nulliparous women and neonatal intracranial injury.Obstet Gynecol,2011,118(6):1239-1246.