背景:新生儿缺氧缺血性脑病(HIE)导致不同程度的神经系统后遗症。HIE的发病率相对较高,导致HIE的因果途径仍然存在争议。本研究旨在调查与HIE相关的危险因素,比较性别之间的差异。
方法:对196例确诊为HIE的新生儿进行横断面研究。根据临床表现的严重程度,他被归类为轻度,中度或重度。对于轻度的HIE,结果相对不那么严重,而中度至重度HIE可能会遭受严重后果,包括死亡,脑瘫,癫痫。T检验,采用卡方检验和logistic回归分析。
结果:在196例新生儿HIE中,39人(19.9%)患有轻度HIE,157例(80.1%)患有中度或重度HIE。Logistic回归分析显示,性别是中重度HIE的具体分层特征。在男性新生儿组中,紧急剖宫产,异常的产程和羊水污染与中度或重度HIE的风险增加有关。其中调整后的比值比(ORs)为4.378(95%置信区间(CI):2.263-6.382),2.827(95%CI:1.743-5.196)和2.653(95CI:1.645-3.972),分别。不出所料,在紧急剖宫产和异常产程之间的相互作用中发现了显着的累加效应,以及紧急剖宫产和羊水污染之间,其中相互作用的相对超额风险分别为2.315(95CI:1.573-3.652)和1.896(95CI:1.337-3.861)。
结论:紧急剖宫产,产程异常和羊水污染是新生儿中重度HIE的危险因素,并且这种关联与男性性别显著相关。值得注意的是,紧急剖宫产与异常产程的发生率一致,羊水污染或紧急剖宫产可能协同增加中度或重度HIE的风险。这些发现可能有助于临床医生加强对影响HIE的风险的认识,并有助于降低临床实践中中度或重度HIE的发生率。
BACKGROUND: Neonatal hypoxic ischemic encephalopathy (HIE) leads to different degrees of neurological sequelae. The incidence of HIE is relatively high, and the causal pathways leading to HIE are still controversial. This study aimed to investigate the risk factors associated with HIE comparing differences between genders.
METHODS: A cross-sectional study of 196 neonates diagnosed with HIE was conducted. Based on the severity of clinical findings, HIE was classified as mild, moderate or severe. For mild HIE, the outcomes were relatively less severe, whereas moderate to severe HIE could suffer serious consequences, including death, cerebral palsy, epilepsy. T-test, chi-square test and logistic regression were used to analyze data.
RESULTS: Among the 196 neonatal HIE, 39 (19.9%) had mild HIE,157 (80.1%) had moderate or severe HIE. The logistic regression analysis showed that gender was a specific stratified characteristic of moderate or severe HIE. In the male neonates group, emergency cesarean section, abnormal labor stage and amniotic fluid contamination were associated with an increased risk of moderate or severe HIE, where the adjusted odds ratios (ORs) were 4.378 (95% confidence intervals (CI):2.263-6.382), 2.827 (95% CI:1.743-5.196) and 2.653 (95%CI:1.645-3.972), respectively. As expected, a significant additive effect was found in the interactions between emergency cesarean section and abnormal labor stage, as well as between emergency cesarean section and amniotic fluid contamination, where the relative excess risk of interaction was 2.315(95%CI:1.573-3.652) and 1.896(95%CI: 1.337-3.861) respectively.
CONCLUSIONS: Emergency cesarean section, abnormal labor stage and amniotic fluid contamination were risk factors of moderate or severe HIE in neonates, and the associations were significantly correlated with male gender. Notably, coinciding incidences of emergency cesarean section with abnormal labor stage, or emergency cesarean section with amniotic fluid contamination were possibly synergistic in increasing the risk of moderate or severe HIE. These findings may assist clinicians in strengthening their awareness on risks affecting HIE and help reduce the incidence of moderate or severe HIE in clinical practice.