新生儿脑损伤产前危险因素分析

目的 探讨新生儿脑损伤产前危险因素。方法 选取2010年8月至2014年2月北京大学第三医院产科分娩并转入儿科的新生儿，行头颅影像学检查诊断为脑损伤者351例，非脑损伤者287例，对其临床资料进行回顾性分析。结果 脑损伤组分娩孕周及新生儿出生体重明显低于非脑损伤组（34.0±3.5）周vs.（35.0±2.8)周；（2059.0±839.6）g vs.（2250.9±726.6）g，均P＜0.05]。28~30周、＞30~32周分娩新生儿发生脑损伤的风险分别是足月分娩的6.6倍和2.1倍。孕周越小新生儿发生脑损伤的风险越高（趋势χ2=26.801，P=0.000）。出生体重小于1500g新生儿发生脑损伤的风险是2000g以上的3.9倍。出生体重越小新生儿发生脑损伤的风险越高（趋势χ2=29.555，P=0.000）。脑损伤组复杂性单绒毛膜双胎比例明显高于非脑损伤组（13.1% vs. 4.5%，P=0.000）。复杂性单绒毛膜双胎新生儿发生脑损伤的风险是单胎的3.0倍。多因素分析显示新生儿发生脑损伤的独立危险因素是分娩孕周（OR=0.891，95%CI 0.842～0.943）、复杂性单绒毛膜双胎（OR=2.180，95%CI 1.108～4.288）。结论 分娩孕周越早新生儿脑损伤风险越高，早产尤其是不足30周且出生体重低于1500g时发生新生儿脑损伤的风险明显增高。复杂性单绒毛膜双胎是发生脑损伤的另一个独立危险因素。

Analysis of antepartum risk factors of neonatal brain injury.

Abstract： Objective To evaluate the antepartum risk factors of neonatal brain injury.Methods Clinical datas of 351 patients with neonatal brain injury in Peking University Third Hospital from August 2010 to February 2014 were studied retrospectively,287 patients without brain injury in the same period as control group. Data was analyzed by SPSS.Results Delivery gestational age and neonatal birth weight（34.0±3.5weeks vs.35.0±2.8weeks，P=0.000；2059.0±839.6gvs.2250.9±726.6g，P=0.002）in brain injury group were significantly lower;for 28 to 30,30 and 32 weeks at delivery, the risk of neonatal brain injury was respectively 6.6 times and 2.1 times more than 37 weeksat delivery.For neonatal birth weight less than 1500 g the risk of brain injury was 3.9 times more than the 2000 g. Complexity monochorionic twins in brain injury group were significantly more（13.1% vs. 13/287，4.5%，P=0.000）. The risk of neonatal brain injury of complexity monochorionic twins was 3.0 times as that of the singletons. Binary logistic regression analysis showed that the independent risk factors for neonatal brain injury were delivery gestational age（OR=0.891，95%CI：0.842～0.943）and complexity monochorionic twins（OR=2.180，95%CI：1.108～4.288）.Conclusions Women with smaller delivery gestational age have higher risk for neonatal brain injury. Complexity monochorionic twins is another independent risk factor.