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Abstract：
BACKGROUND: Peripartum asphyxia is one of the main causes of neonatal morbidity and mortality. In moderate and severe cases of asphyxia, a condition called hypoxic-ischemic encephalopathy (HIE) and associated permanent neurological morbidities may follow. Due to the multifactorial etiology of asphyxia, it may be difficult prevent, but in term neonates, therapeutic cooling can be used to prevent or reduce permanent brain damage. The aim of this study was to assess the significance of different antenatal and delivery related risk factors for moderate and severe HIE and the need for therapeutic hypothermia.
METHODS: We conducted a retrospective matched case-control study in Helsinki University area hospitals during 2013-2017. Newborn singletons with moderate or severe HIE and the need for therapeutic hypothermia were included. They were identified from the hospital database using ICD-codes P91.00, P91.01 and P91.02. For every newborn with the need for therapeutic hypothermia the consecutive term singleton newborn matched by gender, fetal presentation, delivery hospital, and the mode of delivery was selected as a control. Odds ratios (OR) between obstetric and delivery risk factors and the development of HIE were calculated.
RESULTS: Eighty-eight cases with matched controls met the inclusion criteria during the study period. Maternal and infant characteristics among cases and controls were similar, but smoking was more common among cases (aOR 1.46, CI 1.14-1.64, p = 0.003). The incidence of preeclampsia, diabetes and intrauterine growth restriction in groups was equal. Induction of labour (aOR 3.08, CI 1.18-8.05, p = 0.02) and obstetric emergencies (aOR 3.51, CI 1.28-9.60, p = 0.015) were more common in the case group. No difference was detected in the duration of the second stage of labour or the delivery analgesia.
CONCLUSIONS: Smoking, induction of labour and any obstetric emergency, especially shoulder dystocia, increase the risk for HIE and need for therapeutic hypothermia. The decisions upon induction of labour need to be carefully weighed, since maternal smoking and obstetric emergencies can hardly be controlled by the clinician.
METHODS: We conducted a retrospective matched case-control study in Helsinki University area hospitals during 2013-2017. Newborn singletons with moderate or severe HIE and the need for therapeutic hypothermia were included. They were identified from the hospital database using ICD-codes P91.00, P91.01 and P91.02. For every newborn with the need for therapeutic hypothermia the consecutive term singleton newborn matched by gender, fetal presentation, delivery hospital, and the mode of delivery was selected as a control. Odds ratios (OR) between obstetric and delivery risk factors and the development of HIE were calculated.
RESULTS: Eighty-eight cases with matched controls met the inclusion criteria during the study period. Maternal and infant characteristics among cases and controls were similar, but smoking was more common among cases (aOR 1.46, CI 1.14-1.64, p = 0.003). The incidence of preeclampsia, diabetes and intrauterine growth restriction in groups was equal. Induction of labour (aOR 3.08, CI 1.18-8.05, p = 0.02) and obstetric emergencies (aOR 3.51, CI 1.28-9.60, p = 0.015) were more common in the case group. No difference was detected in the duration of the second stage of labour or the delivery analgesia.
CONCLUSIONS: Smoking, induction of labour and any obstetric emergency, especially shoulder dystocia, increase the risk for HIE and need for therapeutic hypothermia. The decisions upon induction of labour need to be carefully weighed, since maternal smoking and obstetric emergencies can hardly be controlled by the clinician.
摘要：
背景：围产期窒息是新生儿发病和死亡的主要原因之一。在中度和重度窒息病例中，随后可能出现一种称为缺氧缺血性脑病(HIE)和相关的永久性神经系统疾病.由于窒息的多因素病因，这可能很难预防，但是在足月新生儿中，治疗冷却可用于预防或减少永久性脑损伤。这项研究的目的是评估中度和重度HIE的不同产前和分娩相关危险因素的重要性以及治疗性低温的需要。
方法：我们在2013-2017年期间在赫尔辛基大学地区医院进行了一项回顾性配对病例对照研究。包括患有中度或重度HIE和需要治疗性低温的新生儿。使用ICD代码P91.00，P91.01和P91.02从医院数据库中识别出它们。对于每个需要治疗性低温的新生儿，按性别选择连续的单胎新生儿，胎儿表现,分娩医院，选择分娩方式作为对照。计算产科和分娩危险因素与HIE发展之间的赔率比（OR）。
结果：88例具有匹配对照的病例在研究期间符合纳入标准。病例和对照组的母婴特征相似，但吸烟在病例中更为常见(aOR1.46，CI1.14-1.64，p=0.003)。先兆子痫的发病率，糖尿病和宫内生长受限组相等.引产（aOR3.08，CI1.18-8.05，p=0.02）和产科紧急情况（aOR3.51，CI1.28-9.60，p=0.015）在病例组中更为常见。在第二产程或分娩镇痛的持续时间中未发现差异。
结论：吸烟，引产和任何产科急诊，尤其是肩难产,增加HIE的风险和治疗性低温的需要。引产的决定需要仔细权衡，因为产妇吸烟和产科急症很难由临床医生控制。
方法：我们在2013-2017年期间在赫尔辛基大学地区医院进行了一项回顾性配对病例对照研究。包括患有中度或重度HIE和需要治疗性低温的新生儿。使用ICD代码P91.00，P91.01和P91.02从医院数据库中识别出它们。对于每个需要治疗性低温的新生儿，按性别选择连续的单胎新生儿，胎儿表现,分娩医院，选择分娩方式作为对照。计算产科和分娩危险因素与HIE发展之间的赔率比（OR）。
结果：88例具有匹配对照的病例在研究期间符合纳入标准。病例和对照组的母婴特征相似，但吸烟在病例中更为常见(aOR1.46，CI1.14-1.64，p=0.003)。先兆子痫的发病率，糖尿病和宫内生长受限组相等.引产（aOR3.08，CI1.18-8.05，p=0.02）和产科紧急情况（aOR3.51，CI1.28-9.60，p=0.015）在病例组中更为常见。在第二产程或分娩镇痛的持续时间中未发现差异。
结论：吸烟，引产和任何产科急诊，尤其是肩难产,增加HIE的风险和治疗性低温的需要。引产的决定需要仔细权衡，因为产妇吸烟和产科急症很难由临床医生控制。
